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College  of  ^f)p&iciani  mh  burgeons; 


1 

TOPOGRAPHY   OF   THE   THORAX   AND 

ABDOMEN 


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Volume  I 


SCIENCE   SERIES 


Number  i 


THE 

UNIVERSITY  OF  MISSOURI 
STUDIES 


TOPOGRAPHY    OF    THE    THORAX   AND 

ABDOMEN 


PETER  POTTER 

Associate    Professor   of  Anatomy  St.    Louis    University     sometime   Instructor    in 
Anatomy  University  of  Missouri 


PUBLISHED    BY    THE 

UNIVERSITY  OF  MISSOURI 
August,  1905 


Copyright  1905,  by 
THE  UNIVERSITY  OF  MISSOURI 


COLUMBIA,  MO.: 

E.    W.    STEPHENS    PUBLISHING    CO. 

1905 


PREFACE 

This  paper  is  the  revised  and  enlarged  form  of  a  thesis 
presented  to  the  University  of  Missouri  in  June,  1903,  for 
the  degree  of  Master  of  Arts ;  and  is  based  upon  work  begun 
in  the  anatomical  laboratory  of  the  University  of  Missouri 
in  1901. 

The  object  of  the  paper  is  to  add  to  the  few  detailed 
observations  upon  the  interrelations  of  the  organs  as  found 
in  a  single  body. 

For  this  purpose,  therefore,  a  body  has  been  studied 
by  the  method  of  sections,  with  reference  to  the  more  im- 
portant thoracic  and  abdominal  organs  and  systems  which 
are  described  individually,  giving  in  each  case  the  topo- 
graphy of  the  part,  its  relations  to  surrounding  structures, 
and  a  comparison  with  the  literature  of  the  subject.  Al- 
though no  attempt  has  been  made  to  exhaust  this  literature, 
reference  is  made  constantly  to  the  text-books  of  descript- 
ive anatomy,  by  Quain,  Cunningham,  Testut,  Bardeleben, 
and  Poirier  and  Charpy;  the  anatomical  atlases  of  Braune, 
Toldt,  Spalteholtz,  Bardeleben  and  Haeckel ;  and  the  topo- 
graphical anatomies  of  Joessel,  Merkel,  Hyrtl,  and  Ruedin- 
ger,  and  special  articles  and  monographs  by  Henke,  Toep- 
ken,  Schiefferdecker,  Addison  and  others.  After  each  dis- 
cussion, there  is  indicated,  briefly,  the  more  important 
points  of  difference  between  the  relations  of  the  organs 
found  in  the  trunk  described  in  this  paper  and  those  de- 
scribed by  the  authors  named. 


I  have  been  at  all  times  greatly  assisted  by  the  advice 
of  Dr.  C.  AI.  Jackson,  under  whose  direction  the  work  was 
commenced  and  who  has  untiringly  aided  until  its  comple- 
tion. 

I  am  also  under  obligations  to  Dr.  A.  C.  Eyclesheimer, 
of  St.  Louis  University,  Dr.  D.  D.  Lewis,  of  the  University 
of  Chicago,  and  to  Dr.  L.  F.  Barker,  of  the  Johns  Hopkins 
University ,  for  many  helpful  suggestions  and  encourage- 
ment. 

I  am  greatly  indebted  to  Mr.  Roy  Dimmitt,  superin- 
tendent of  Manual  Arts,  Birmingham  Public  Schools,  Bir- 
mingham, Alabama,  for  lettering  the  plates;  and  to  Mr. 
Alfred  Streedain,  artist  to  the  department  of  Anatomy,  St. 
Louis  University,  for  lettering  the  projections. 


TABLE  OF  CONTENTS 


CHAPTER  PAGE 

Introduction    .........      i 

Material  and  Methods     .......    5 

Topography  of  the  Organs 

Skeleton    .    .    .    .    .    .    .    .12 

Lungs    .    .    .    .    .    .    .    .    •   ^5 

Trachea    ........    25 

Heart    .........  27 

Aorta  and  Venae  Cavae    ...     .34 

Oesophagus   ....    .    .    .    -37 

Stomach    ........    3S 

Duodenum  and  Jejunoileum     .         .         .         .         '41 

Large  Intestine      .......         43 

Liver  .........       48 

Pancreas       ........         54 

Spleen       .         .         . 56 

Kidneys         ........  57 

Ureters  and  Bladder       ......     60 

Suprarenal  Glands  ...  .  .  61 

Thyreoid  Gland     .....  .  .62 

Table  of  Levels  .....  .  .  63 

Table  of  Structures  Found  at  Various  Levels         .         .         65 
Plates      ...........        69 


TOPOGRAPHY  OF  THE  THORAX 
AND  ABDOMEN 


INTRODUCTION 


THE  use  of  sections  in  the  study  of  human  topographic 
anatomy  can  be  traced  back  for  several  centuries. 
They  were  used  to  illustrate  the  works  of  Vesalius  (1555), 
Eustachius  (1564)  and  numerous  anatomists  of  the  seven- 
teenth and  eighteenth  centuries.  These  illustrations  con- 
sist chiefly  of  crude  and  schematic  representations  of  head 
and  pelvic  sections. 

De  Riemer,!  a  Dutch  anatomist,  made  sections  of  the 
frozen  body  in  1803  and  published  his  atlas  in  1818. 

Froriep,^  of  Tubingen,  made  sections  of  frozen  arms  and 
legs  in  1813  and  of  frozen  female  pelves  in  1815.  He  an- 
nounced as  his  most  striking  observation  "the  entirely  new 
view  of  the  relations  of  the  parts  given  by  the  method." 
This  view  was  so  different  from  that  obtained  by  the  ordi- 
nary methods  of  study  that  he  states :  "It  is  necessary  for 
one  to  feel  one's  way,  as  it  were,  among  the  parts." 

1  De  Riemer,  P.,  Exposition  de  la  position  exactedes  parties  internes 
du  corps  humain,  tant  par  rapport  h  leur  position  mutuelle,  que  par  leur 
contact  aux  parois  des  cavit^s  ou  elles  se  trouvent  plac^es;  avec  une  de- 
scription explfcative  y  relative.     La  Haye,  i8i8. 

2  Froriep,  Ludwig  Friedrich  V.,  Ueber  anatomie  in  beziehung  auf 
chirurgie.  Nebst  einer  darstellung  der  relativen  dicke  und  lage  der 
muskeln  am  ober-und  unterschenkel.  Weimar,  1813.  Ueber  die  lage 
der  eingeweide  im  becken,  nebst  einer  neuen  darstellung  derselben. 
Weimar,  1815. 

I 


2  UNIVERSITY  OF  MISSOURI  STUDIES 

Pirogoff,^  a  Russian  surgeon  and  anatomist,  reinvented 
the  method  of  frozen  sections  and  used  it  very  extensively. 
His  work,  in  five  large  volumes,  contains  over  200  figures 
of  sections  through  various  parts  of  the  body,  illustrating 
both  normal  and  pathological  conditions. 

Braune,^  a  German  anatomist,  used  the  method  of 
frozen  sections  in  his  study  of  topographic  anatomy.  While 
his  atlas  is  less  extensive  than  that  of  Pirogoff  it  is  far  more 
accurate  and  his  colored  lithographic  plates  are  (to  this  day) 
the  best  reproduction  of  sections  through  the  human  body. 

I  have  not  given  the  names  of  all  of  the  workers  along 
this  line  but  have  only  indicated  the  main  steps  in  the  de- 
velopment of  the  use  of  sections  in  the  study  of  topographic 
anatomy.  Even  though  this  method  has  been  in  use  for 
several  centuries  it  was  not  until  recently  that  any  marked 
advance  was  made.  Each  worker,  when  he  first  began  the 
use  of  sections,  expressed  surprise  at  the  great  difference 
between  the  impressions  obtained  from  the  ordinary 
methods  of  study  and  those  obtained  from  a  study  of  sec- 
tions. Yet  many  of  these  workers  disregarded  the  results 
to  be  derived  from  the  study  of  their  sections  and  held  to 
their  ideas  derived  from  other  sources.  In  some  instances 
the  reproductions  of  the  sections  show  wide  deviations  from 
the  statements  in  the  text. 

It  was  not  until  Henke^    suggested  the  construction, 

3  Pirogoff,  Nicolas,  Anatome  topographica  sectionibus  per  corpus 
humanum  congelatum  Iriplici  directione  ductis  illustrata.  Petropoli, 
1852-9. 

*  Braune,  W.,Topographisch-anatomischer  atlas.  Nach  durchschnit- 
ten  an  gefrorenen  cadavern.     3  Aufl.  Leipzig,  1886-8. 

*  Henke,  W.,  Construction  der  lage  des  herzens  in  der  leiche  aus 
einer  serie  von  horizontalschnitten.     Tiibingen,  1883. 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN  3 

from  sections,  of  charts  showing  the  positions  of  the  organs 
of  the  body  that  there  was  any  advance  beyond  what 
Froriep  had  announced  nearly  seventy  years  before. 

Henke's  method  is,  briefly,  to  establish  a  vertical  line, 
representing  the  median  sagittal  plane  of  the  body,  crossed 
by  horizontal  lines  representing  the  positions  of  the  sections 
from  which  the  projection  is  to  be  made.  Any  point  in  any 
section  can  be  accurately  projected  upon  the  chart  by  using 
the  vertical  line  and  the  proper  horizontal  line  as  coordi- 
nates. 

This  method  of  recording  observations  marks  the  be- 
ginning of  a  new  epoch  in  topographic  anatomy,  because  it 
puts  each  part  into  a  concrete  form  and  thus  lessens  the  lia- 
bility of  error.  At  the  present  time,  all  writers  on  topo- 
graphic anatomy  give  the  section  method  a  prominent  place 
as  a  method  of  study. 

Not  only  has  the  method  of  recording  observations 
changed  but  also  the  method  of  preparation  of  the  sections. 
The  original  method  (that  used  by  all  the  anatomists  re- 
ferred to)  was  to  freeze  the  body  thoroughly  and  while 
frozen  to  saw  it  into  sections  of  the  desired  shape  and  thick- 
ness. The  sections  were  then  placed  in  strong  alcohol  and 
allowed  to  thaw  slowly.  The  results  were  not  entirely 
satisfactory  since  the  organs  did  not  always  become  suffi- 
ciently firm  to  retain  their  exact  form  and  relations,  and  the 
shrinkage  was  unequal  in  the  different  organs.  Moreover 
the  surfaces  were  somewhat  rough  from  the  sawing  so  that 
it  was  difficult  to  recognize  the  finer  structures. 

A  distinct  step  in  advance  was  made  when  formalin,  as 
a  hardening  reagent,  was  introduced  into  the  methods  of 


4  UNIVERSITY  OF  MISSOURI  STUDIES 

preparation.  It  was  first  employed,  by  F.  Blum,^  in  micro- 
scopic technique  and  afterwards  by  Gerota  in  topographic 
anatomy.  Gerota'  suggested  the  injection  of  a  five  per 
cent  solution  of  formalin  into  the  arteries  and  the  sectioning 
of  the  frozen  body  in  the  usual  way.  Jackson^  has  recently 
and  independently  shown  that  by  the  use  of  a  fifty  per  cent 
solution  of  formalin  it  is  not  necessary  to  freeze  the  body 
before  sectioning.  The  advantages  of  this  method  are  that 
the  organs,  hardened  in  the  exact  form  and  position  they 
were  in  at  the  time  the  body  was  injected,  do  not  change 
after  the  sections  are  made ;  all  parts  except  the  bones  can 
be  cut  with  a  knife,  thus  giving  smooth,  even  surfaces.  It 
is  also  possible  to  decalcify  after  hardening  with  formalin, 
but  this  is  seldom  necessarv  or  desirable. 


6  Blum,  F.,  Das  formaldehyd  als  hartungsmittel.  Vorlaufige 
mitteilung.     Zeitschrift  f.  wiss.  mikroskopie,  Bd.  lo.  1893. 

'^  Gerota,  D.,  Ueber  die  anwendung  des  formols  in  der  topographis- 
chen  anatomic.     Anat.  anzeiger,   Bd.   11.   1S95. 

8  Jackson,  C.  M.,  A  method  of  teaching  relational  anatomy. 
Journal  of  the  american  medical  association,  1901. 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN 


AIATERIAL  AND  METHODS 

The  sections  upon  which  this  paper  is  based  were  made, 
according  to  Jackson's  method,  from  the  body  of  a  negro 
man  about  thirty  years  of  age,  six  feet  in  height  and  about 
one  hundred  and  ninety  pounds  in  weight.  The  body  was 
well  proportioned,  the  muscles  were  well  developed,  there 
was  no  surplus  fat  and  no  external  signs  of  abnormal  or 
pathological  conditions.  Just  after  a  full  meal  the  man  died 
from  asphyxia  while  cleaning  an  old  well.  The  body  came 
into  the  anatomical  laboratory  of  the  University  of  Missouri 
a  few  hours  after  death  and  was  at  once  injected,  through 
the  femoral  artery,  with  about  six  quarts  of  fifty  per  cent 
formalin  (twenty  per  cent  formaldehyde).^  Care  was  taken 
to  have  the  body  straight  (in  the  dorsal  position)  and  the 
limbs  in  their  normal  position.  Within  twelve  hours  after 
being  injected  the  entire  body  was  perfectly  rigid.  A  few 
weeks  later  the  trunk  was  cut  into  twenty-five  cross-sections 
with  a  long  knife  and  saw.  It  was  the  intention  to  have 
each  cut  pass  through  an  intervertebral  disc  but  this  was 
not  accomplished  in  every  case.  The  surfaces  of  the  sec- 
tions should  have  been  horizontal  and  parallel  to  each  other, 
but  those  through  the  upper  part  of  thorax  are  lower  and 
thinner  in  front  than  behind.     As  each  section  was  made 

the  loose  pieces  and  parts  liable  to  be  displaced  were  stitched 

t 

in  place  with  needle  and  thread.     The  body  was  so  thor- 

1  A  small  quantity  of  a  weak  formalin  solution  had  already  been 
injected  into  the  peritoneal  cavity  by  an  undertaker.  This  causes  the 
abnormal  dilatation  of  the  peritoneal  spaces  seen  between  the  organs 
in  the  abdominal  sections. 


6  UNIVERSITY  OF  MISSOURI    STUDIES 

oughly  hardened  that  each  organ  shows  the  impressions 
made  upon  it  by  the  adjacent  organs  and  retains  its  form 
even  though  it  is  cut  into  relatively  thin  sections.  The 
main  structures  in  each  section  were  identified  without  dis- 
turbing the  relations  of  the  parts. 

While  every  part  was  yet  in  its  normal  position,  a  draw- 
ing was  made  of  each  section  by  placing  a  thin  plate  of  glass 
on  its  upper  surface  and  tracing  the  outline  of  the  parts  with 
a  fine  pen  and  India  ink.  The  tracing  was  readily  trans- 
ferred to  paper  by  placing  the  sheet  on  the  glass  over  the 
drawing,  holding  them  up  to  the  light  and  retracing  the  out- 
line on  the  paper.  In  making  the  tracings  each  line  was 
drawn  with  the  eye  and  pen  directly  over  the  same  part,  thus 
avoiding  displacement  on  account  of  the  thickness  of  the 
glass. 

For  the  purpose  of  uniformity  and  in  order  to  avoid 
unnecessary  confusion  all  the  plates  represent  the  sec- 
tion as  viewed  from  above  with  its  posterior  portion  toward 
the  top  of  the  page.* 

After  the  permanent  outline  records  of  the  undisturbed 
parts  had  been  thus  obtained  each  section  was  studied  in 
minute  detail.  Every  part  was  followed  from  its  beginning 
to  its  end  through  every  section  in  which  it  appears.  Ves- 
sels and  other  hollow  structures  were  traced  by  passing  a 
bristle  through  the  lumen.  Nerves,  muscles,  tendons,  and 
all  solid  structures  were  traced  by  dissecting  the  connective 
tissue  away  from  one  side  of  each  so  that  they  could  be 
followed  through  the  section  and  definitely  located  in  the 
next  section. 

^Jackson,  C.  M.,  Orientation  of  figures   in  topographical   anatomy, 
nat.  anzeiger,  Bd.  20.  1901,  s.  300. 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN  7 

In  order  to  avoid  errors,  each  plate  was  finished  with 
the  section  from  which  it  was  taken  before  me.  No  attempt 
has  been  made  to  reproduce  the  parts  in  their  natural  colors 
or  appearances.  All  finishing  lines  are  more  or  less  conven- 
tional and  only  attempt  to  give  sufficient  contrast  so  that 
the  parts  may  be  readily  distinguished. 

The  bones  are  indicated  by  a  central  stippled  area  repre- 
senting the  cancellous  bone,  surrounded  by  a  clear  area  rep- 
resenting the  compact  bone.  The  intervertebral  discs  and 
costal  cartilages  are  white.  The  muscles  are  lined  in  one 
direction  only,  with  the  exception  that  the  diaphragm  and 
the  walls  of  the  heart  are  cross-lined.  The  arteries  are  red 
and  the  veins  blue  as  are  also  the  corresponding  parts  of 
the  heart.  The  cavities  of  the  body  are  black,  except  for  a 
narrow  white  line  around  the  boundary  of  each  space.  The 
nerves  appear  as  circles.  The  spinal  cord  contains  the 
sign  H.  The  liver  is  lined  with  lines  oblique  to  those  of 
the  muscles.  The  spleen  and  some  of  the  lymph  glands  are 
filled  in  by  circles.  The  lungs,  thyreoid  gland  and  pancreas 
are  represented  as  composed  of  angular  spaces.  The  irreg- 
ular line  in  the  suprarenal  gland  represents  the  medulla  of 
the  gland.  The  kidney  shows  the  radiate  appearance  of  the 
medullary  substance.  The  ureter  is  shown  as  a  small 
double  walled  tube  with  its  inner  wall  wrinkled.  The  vas 
deferens  is  also  double  walled  but  the  inner  circle  is  very 
small.  The  sections  of  the  alimentary  canal  are  outlined 
only.  The  outer  line  represents  the  peritonaeal  coat,  the 
inner  line  the  mucous  coat  and  the  interspace  the  remain- 
ing layers. 

In  a  few  sections  uncut  parts  which  lie  near  enough  to 
the  surface  of  the  section  to  make  it  desirable  to  indicate 


S  UNIVERSITY  OF  MISSOURI  STUDIES 

their  position  are  shown  in  the  plates  in  dotted  outlines. 

The  projections  were  made  from  careful  measurements 
of  the  organs  at  the  surface  of  the  several  sections.  The 
measurements  were  made  by  means  of  a  plate  of  glass,  the 
surface  of  which  was  ruled  with  parallel  lines  1  cm.  apart. 
The  center  line  and  every  fifth  line  was  colored  to  facili- 
tate the  reading. 

The  ruled  surface  of  the  glass  was  placed  upon  the 
drawing  so  that  the  lines  would  be  in  immediate  contact 
with  the  parts  to  be  measured.  To  exclude  errors,  a  dupli- 
cate set  of  measurements  was  taken  in  the  same  way  directly 
from  the  sections.  For  projections  upon  the  anterior  and 
posterior  surfaces  of  the  body  the  middle  line  of  the  glass 
was  always  placed  over  the  anteroposterior  midline  of  the 
plate.  This  midline  of  the  section  was  taken  as  a  line 
through  the  middle  of  the  sternum  or  linea  alba  anteriorly 
and  the  center  of  the  centrum  or  intervertebral  disc  post- 
eriorly. It  does  not  pass  through  the  spinous  process  in 
those  cases  where  the  latter  is  displaced  to  the  right  or  left 
as  sometimes  happens. 

The  midline  thus  established  was  taken  as  the  zero 
line  of  the  section  and  the  measurements  were  made  to  the 
right  and  left  with  it  as  the  line  of  reference.  Since  the 
projection  could  only  show  the  outline  of  an  organ  the  point 
nearest  the  midline  and  the  one  farthest  from  the  midline 
were  the  two  measured.  Where  an  organ  crossed  the  mid- 
line, the  points  representing  the  two  lateral  extremities  were 
taken.  The  same  measurements  were  used  for  both  pro- 
jections. In  the  case  of  the  lungs,  however,  two  sets  of 
measurements  were  taken,  one  for  the  anterior  projection 
and  the  other  for  the  posterior.  The  anterior  margins  and 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN         9 

external  surfaces  were  taken  for  the  anterior  projection 
(Plate  XXVIII),  and  the  most  internal  portions  in  the 
region  of  the  posterior  mediastinum  (crista  pulmonis  of 
Merkef)  and  the  external  surfaces  for  the  posterior  projec- 
tion. This  difference  was  made  to  show  the  more  direct 
relations  of  the  lungs  to  the  sternum  and  to  the  vertebral 
column  respectively. 

The  points  measured  upon  any  section  were  located 
on  millimeter  cross-section  paper,  on  the  horizontal  line 
representing  the  upper  surface  of  that  section,  at  distances 
from  the  zero  line  equal  respectively  to  their  several  dis- 
tances from  the  midline  of  the  section.  In  case  the  plane  of 
the  section  was  exactly  horizontal,  as  in  Plate  XI,  the 
points  so  located  were  points  through  which  the  outline  of 
the  corresponding  organs  must  pass.  But  in  those  cases 
where  the  anterior  and  posterior  margins  of  the  section 
were  at  different  levels,  as  in  Plate  VI,  correction  had  to  be 
made  for  the  obliquity  of  the  plane. 

By  careful  dissections  and  comparison  of  the  sections, 
the  outline  of  each  organ  was  made  as  nearly  accurate  as 
possible  as  to  shape  and  size.  When  the  outlines  were 
penciled  in  and  had  been  carefully  compared  with  the 
organs,  they  were  retraced  with  ink  in  the  broken  lines  in 
which  they  appear  in  the  plates. 

It  must  be  remembered  in  examining  the  projections 
that  the  cross-lines  represent  planes  which  are  practically 
parallel  and  that  the  outline  of  any  organ  at  a  given  level  is 
as  it  would  appear  with  the  eye  in  that  horizontal  plane,  and 
not  as  it  would  appear  to  the  eye  at  any  point  outside  of  the 

1  Merkel,  F.,  Bardeleben's  Handbuch  der  anatomic.  Bd.  VI. 
Abthl.  I. 


lO  UNIVERSITY  OF  MISSOURI  STUDIES 

horizontal  plane.  Since  every  point  upon  the  outline  of  an 
organ  has  been  projected  along  a  horizontal  line  parallel 
to  the  mid-plane  from  its  position  on  the  organ  to  the 
(anterior  or  posterior)  surface  of  the  body,  it  is  necessary 
in  order  to  see  that  point  in  its  correct  relations,  to  imagine 
that  the  eye  is  in  the  line  of  projection.  The  position  of  the 
eye  must  change,  therefore,  for  every  object  viewed,  and  the 
projections  do  not  represent  exactly  what  would  be  seen 
if  the  body  were  transparent  and  viewed  from  a  single 
point. 

The  nomenclature  adopted  by  the  German  Anatomical 
Society  at  its  meeting  in  Basel,  1895  [BNA]  is  used  in 
Plates  I  to  XXV.  The  intervertebral  discs  are  designated 
by  Roman  numerals ;  the  number  in  each  case  correspond- 
ing with  the  vertebra  above. 

The  following  topographic  lines  and  directions  are 
used: 

The  midline  of  a  section  is  a  line  passing  through  the 
middle  of  the  sternum  or  linea  alba  anteriorly  and  the  center 
of  the  body  of  the  vertebra  posteriorly.  The  midplane  of 
the  body  is  a  vertical  plane  which  contains  the  midlines  of 
the  sections.  Upon  the  anterior  surface  of  the  body  this 
plane  would  appear  as  a  line  passing  through  the  middle 
of  the  sternum  and  the  linea  alba  (anterior  midline  "OO," 
Plate  XXVIII)  and  upon  the  posterior  surface  as  the  pos- 
terior midline  ("OO,"  Plate  XXIX). 

The  midclavicular  line  is  a  vertical  line  through  the 
middle  of  the  clavicle,  as  seen  in  projection.  It  is  about  8 
cm.  from  the  midplane. 

The  midaxillary  line  is  a  vertical  line  through  the  apex 
of  the  axilla  when  the  arm  is  in  its  normal  position  ("OO," 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN        i  i 

Plates  XXX  and  XXXI).  The  plane  connecting  the  two 
midaxillary  lines  is  the  midaxillary  plane. 

The  terms  right  and  left  are  used  as  applied  to  the  body 
of  the  subject  and  not  to  that  of  the  observer,  e.  g.  the  apex 
of  the  heart  is  on  the  left  side  of  the  subject  and  opposite 
the  right  side  of  the  observer. 

The  term  section  refers  to  one  of  the  parts  into  which 
the  body  is  cut.  A  section  is  located  by  the  level  of  its 
upper  surface,  as  section  X  is  through  the  seventh  thoracic 
vertebra  posteriorly  and  the  third  intercostal  muscles  anter- 
iorly because  in  making  this  section  these  structures  were 
cut  by  the  knife  and  saw. 


TOPOGRAPHY   OF   THE    ORGANS 


THE  SKELETON 

The  vertebral  column  is  about  4  cm.  wide  in  the  upper 
thoracic  region.  It  decreases  very  slightly  down  to  the 
middle  of  the  thoracic  region.  From  here  downward  it  in- 
creases gradually  until  it  is  over  6  cm.  wide  at  the  sacrum. 
There  is  a  gradual  increase  in  the  thickness  of  the  centra. 
The  first  thoracic  centrum  is  1.5  cm.,  the  third  lumbar  cen- 
trum is  2.7  cm.  thick.  The  fourth  and  fifth  lumbar  centra 
are  about  the  thickness  of  the  first  and  second.  The 
intervertebral  discs  correspond  in  width  and  thickness  to  the 
centra.  The  disc  between  the  first  and  second  thoracic  verte- 
brae is  only  .5  cm.  in  thickness,  while  that  between  the  third 
and  fourth  lumbar  vertebrae  is  1.2  cm.,  in  thickness.  The 
fourth  and  fifth  lumbar  discs  are  about  the  same  thickness 
as  the  first  and  second.  When  seen  from  the  side  (Plates 
XXX  and  XXXI)  the  vertebral  column  is  S-shaped.  On 
account  of  a  slight  kyphosis  the  convexity  in  the  upper 
thoracic  region  is  a  little  greater  than  usual.  For  this  same 
reason  the  spinous  processes  of  the  first  three  thoracic  verte- 
brae are  nearly  horizontal. 

The  sternum  extends  from  the  level  of  the  upper  part 
of  the  third  to  the  level  of  the  lower  part  of  the  eleventh 
thoracic  vertebra.  The  sternal  angle  is  at  the  level  of  the 
lower  border  of  the  fourth  thoracic  vertebra.  The  gladiolus 
extends  from  the  lower  border  of  the  fourth  to  the  middle 
of  the   ninth   thoracic   vertebra.     The   xiphoid   process   is 

12 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN        1 3 

diamond-shaped  and  is  located  anterior  to  the  lower  half 
of  the  ninth  and  the  tenth  and  eleventh  vertebrae.  It  is  in- 
clined to  the  right  of  the  midline,  and  is  more  firmly  at- 
tached to  the  cartilage  of  the  right  seventh  rib  than  to  the 
gladiolus. 

The  costochondral  articulations  from  the  first  to  the 
tenth,  lie  in  a  straight  line,  oblique  to  the  midline,  which 
(in  projection)  is  about  5  cm.  from  the  midline  at  the  first 
rib  and  about  13  cm.  at  the  tenth  rib.  The  subcostal  angle 
is  about  70^.  The  sternal  ends  of  the  clavicles  are  in  front 
of  the  second  thoracic  intervertebral  disc  and  the  upper  half 
of  the  third  vertebra.  The  scapula  extends  from  the  fifth 
cervical  intervertebral  disc  to  the  lower  part  of  the  seventh 
thoracic  vertebra.  The  glenoid  cavity  is  opposite  the  first 
thoracic  vertebra. 

The  highest  point  of  the  crest  of  the  ilium  is  at  the 
level  of  the  fourth  lumbar  vertebra.  The  tip  of  the  coccyx 
reaches  the  level  of  the  middle  of  the  symphysis  pubis  and 
the  upper  border  of  the  great  trochanters  of  the  femur. 

The  right  nipple  is  over  the  fifth  rib.  The  left  one  is 
partly  over  the  fifth  rib  and  partly  over  the  fourth  inter- 
costal space.  Each  one  is  about  11  cm.  from  the  midline. 
The  umbilicus  is  in  front  of  the  upper  half  of  the  fourth 
lumbar  vertebra. 

The  majority  of  the  texts  consulted  give  insufficient 
data  on  the  topography  of  the  skeleton  for  a  very  satisfactory 
comparison.  I  believe,  however,  that  the  anterior  thoracic 
wall  is  relatively  low  in  this  subject.  The  manubrium  is  more 
than  1cm.  below  where  it  would  be  if  found  at  the  lower  part 
of  the  second  thoracic  vertebra,  as  stated  by  Cunningham^, 


^Cunningham,  D.  J.,  A  text  book  of  anatomy.     New  York,  1903. 


I^  UNIVERSITY   OF    MISSOURI   STUDIES 

Poirier  and  Charpyi,  and  Mehnert^.  According  to 
Mehnert,  who  has  made  a  careful  study  of  the  topography 
of  the  thoracic  organs,  the  upper  border  of  the  sternum  in 
adults  usually  corresponds  to  the  second  thoracic  vertebra 
or  to  the  disc  below.  Occasionally  it  reaches  the  third  as  in 
this  case.  It  is  probable  that  the  bending  forward  of  the 
upper  thoracic  portion  of  the  vertebral  column  has  forced 
the  manubrium  down  to  the  level  of  the  third  vertebra. 

There  seem  to  be  several  diiterences  between  the  pro- 
jections given  by  Hermann  and  RuedeP  and  those  given 
in  this  paper.  But  no  definite  conclusions  can  be  drawn 
from  their  projections  since  they  have  not  projected  the 
skeleton  and  viscera  in  the  same  figure.  There  are  no  de- 
scriptions of  the  projections  nor  any  explanation  as  to  how 
they  were  made.  ^Moreover  the  projections  themselves  do 
not  appear  to  be  very  accurate.  I  made  careful  tracings  of 
their  projection  of  the  skeleton  upon  the  anterior  surface  of 
the  body  and  placed  it  over  the  corresponding  projections 
of  the  viscera.  I  found  that  the  parts  common  to  the  pro- 
jection of  the  skeleton  and  that  of  the  organs  (i.  e.,  the 
cross-lines  indicating  the  position  of  the  surfaces  of  the  sec- 
tions, the  body  outline,  the  clavicles,  the  sternum  and  the 
subcostal  angle,  which  are  found  in  both  projections)  do 
not  coincide  as  they  should.  Their  table  of  levels  may 
therefore  be  taken  as  of  more  value  than  their  projections, 
and  will  be  referred  to  as  the  various  organs  are  discussed. 

iPoirier,  P.  et  Charpy,  A.,  Traits  d'anatomie  humaine.  I.  Paris, 
1899. 

^Mehnert,  E.,  Ueber  topographische  altersveranderungen  des 
atmungsapparates.     Jena,  1901. 

'Hermann,  F.  und  Ruedel,  O.,  Dielage  der  eingeweide.  Erlangen, 
1895. 


TOPOGRAPHY   OF  THE  THORAX   AND  ABDOMEN  15 

THE  LUNGS 

The  lunps  appear  in  Plates  V  to  XIII  and  XXVIII  to 
XXXV.  While  the  left  lung  is  adherent  to  the  pleural  wall 
throughout,  its  substance  seems  to  be  perfectly  normal.  The 
apex  of  the  right  lung  is  about  2  cm.  and  that  of  the  left 
lung  about  2.5  cm.  above  the  upper  border  of  the  middle  of 
the  inner  third  of  the  clavicle,  on  a  level  with  the  middle  of 
the  first  thoracic  vertebra  3.5  cm.  from  the  midline.  By 
projecting  up  into  the  neck  each  apex  comes  into  relations 
with  the  structures  above  the  clavicle.  The  eighth  cervical 
nerve  and  the  lower  trunk  of  the  brachial  plexus  cross  it 
from  above  outward  and  forward,  while  the  sympathetic 
cord  and  inferi:or  cervical  ganglion  rest  upon  it  internally. 
The  vertebral  and  ascending  cervical  vessels  lie  upon  the 
anterior  part  of  the  pleural  dome  in  their  passage  upward 
into  the  neck.  The  arch  of  the  thoracic  duct  is  separated 
from  the  left  apex  by  these  vessels  (Plate  IV).  The  sub- 
clavian artery  arches  across  the  apex  less  than  1  cm.  from 
its  highest  point  and  separates  the  lung  from  the  scalenus 
anterior  muscle  and  the  internal  jugular  vein.  The  innom- 
inate vein  lies  just  below  the  subclavian  artery  and  separates 
the  lung  and  sternoclavicular  articulation.  When  seen  in 
anterior  projection  the  apex  of  each  lung  is  overlapped  by 
the  lower  part  of  the  corresponding  lateral  lobe  of  the  thy- 
reoid gland  (Plates  XXVIII  and  XXXII).  The  two  organs 
are  not  in  contact  however  (Plates  XXX,  XXXI, 
XXXIV  and  XXXV).  The  apex  of  the  lung  comes  nearly 
to  the  surface  of  section  IV  in  the  quadrilateral  space  in 
front  of  the  neck  of  the  first  rib  where  it  is  6  or  7  cm.  from 
the  anterior  surface  of  the  neck  and  where  it  is  separated 
from  the  thyreoid  gland  by  the  vertebral  and  ascending  cer- 
vical vessels,  and  the  internal  part  of  the  carotid  sheath 


l6  UNIVERSITY  OF  MISSOURI    STUDIES 

containing-  the  common  carotid  artery.  On  the  left  side 
the  thoracic  duct  is  along  with  the  ascending  cervical  ves- 
sels. 

If  a  needle  were  inserted  directly  backward  through 
the  middle  of  the  sternal  head  of  the  sternomastoid  about 
2  cm.  above  the  clavicle  it  would  enter  the  highest  part  of 
the  apex  of  the  lung.  The  needle  would  pass  through  the 
skin,  platysma  and  sternomastoid  muscles  between  the  in- 
ternal jugular  vein  and  the  thyreoid  gland,  through  the 
common  carotid  artery  and  into  the  space  containing  the 
vertebral  and  ascending  cervical  vessels.  On  the  left  side 
it  would  pierce  the  thoracic  duct.  In  each  case  the  highest 
part  of  the  apex  lies  a  little  internal  to  the  interspace  be- 
tween the  two  heads  of  the  sternomastoid. 

The  anterior  border  of  the  right  lung  is  very  indistinct 
above  but  is  more  plainly  marked  below.  From  the  apex 
it  passes  downward  behind  the  upper  border  of  the  sternum 
a  little  internal  to  the  sternoclavicular  articulation,  and  re- 
mains behind  the  right  half  of  the  sternum  down  to  the  sixth 
sternochondral  articulation,  where  it  becomes  continuous 
with  the  inferior  margin  of  the  lung  (Plates  XXVIII  and 
XXXII).  The  anterior  border  of  the  left  lung  is  more 
plainly  marked  above  than  that  of  the  right.  It  is  deeply 
concave  below  where  the  heart  encroaches  upon  this  lung 
more  than  upon  the  right  one  (Plates  XXVIII  and  XXXII). 
Beginning  at  the  apex  the  anterior  border  may  be  traced 
downward  and  inward  behind  the  left  sternoclavicular  and 
first  sternochondral  articulations.  It  passes  to  the  left  of 
the  sternum  in  the  first  intercostal  space  and  runs  downward 
and  outward  to  the  middle  of  the  fourth  intercostal  space  in 
the  midclavicular  line.  Here  it  turns  inward,  crosses  the 
fifth  rib  1  cm.  internal  to  the  midclavicular  line  and  becomes 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN        I'J 

continuous  with  the  inferior  margin  of  the  lung  in  the  fifth 
intercostal  space. 

The  posterior  border  (or  posterior  surface)  of  each 
lung  is  separated  from  the  corresponding  internal  surface 
by  a  ridge — crista  pulmonis  of  Merkel — more  plainly  seen 
above  the  hilus  than  below  it  (Plates  VI  and  VII).  The 
crista  of  the  right  lung  (seen  in  projection  in  Plates  XXIX 
and  XXXIII)  lies  anterior  to  the  right  half  of  the  vertebral 
column  from  the  second  to  the  ninth  thoracic  vertebra.  It 
becomes  continuous  with  the  posterior  part  of  the  inferior 
margin  opposite  the  disc  between  the  ninth  and  tenth  ver- 
tebrae. The  crista  of  the  left  lung  lies  a  little  farther  from 
the  midline  and  extends  down  to  the  side  of  the  tenth  verte- 
bra where  it  turns  outward  to  join  the  inferior  margin  in 
the  tenth  intercostal  space,  at  the  level  of  the  disc  between 
the  tenth  and  eleventh  vertebrae. 

The  external  surface  of  each  lung  is  convex  in  all  di- 
rections and  presents  a  regular  curve  from  apex  to  base 
which  follows  the  concave  internal  surfaces  of  the  thoracic 
wall.  These  surfaces  are  crossed  by  oblique  grooves  which 
are  the  external  limits  of  the  fissures  dividing  the  lungs 
into  lobes.  The  lines  in  the  projections  indicating  these 
fissures  represent  them  as  seen  on  the  surfaces  of  the  lungs. 
It  must  be  borne  in  mind  that  the  relations  of  a  fissure  to  the 
ribs  when  seen  from  the  front  or  back  (Plates  XXVIII, 
XXIX,  XXXII  and  XXXIII)  do  not  correspond  exactly  to 
those  when  seen  from  the  sides,  (Plates  XXX,  XXXI, 
XXXIV  and  XXXV). 

The  great  fissure  of  the  right  lung  begins  behind,  oppo- 
site the  centrum  of  the  fourth  vertebra,  between  the  spines 
of  the  third  and  fourth  vertebrae,  passes  outward  under 
cover  of  the  fifth  rib  to  cross  the  midaxillary  line  in  the 
fifth  intercostal  space  and  ends  in  the  inferior  margin  of 


l8  UNIVERSITY  OF  MISSOURI  STUDIES 

the  lung  in  the  sixth  intercostal  space,  about  1.5  cm.  exter- 
nal to  the  midclavicular  line.  The  horizontal  fissure  begins 
in  the  great  fissure  just  posterior  to  the  midaxillary  line 
and  runs  inward  and  a  little  downward  behind  the  third  in- 
tercostal space  to  end  in  the  anterior  margin  of  the  lung 
behind  the  fourth  sternochondral  articulation.  The  great 
fissure  of  the  left  lung  begins  behind,  a  little  higher  than 
that  of  the  right  lung.  It  is,  at  first,  at  the  level  of  the  disc 
between  the  third  and  fourth  vertebrae  and  runs  downward 
and  outward  across  the  fourth  intercostal  space  and  the  fifth 
rib  to  cross  the  midaxillary  line  in  the  fifth  intercostal 
space.  Here  it  takes  a  more  vertical  direction  and  ends  in 
the  inferior  margin  of  the  lung  at  the  upper  border  of  the 
sixth  rib  a  little  external  to  the  midclavicular  line.  A  very 
narrow  strip  of  the  external  part  of  the  inferior  lobe  is 
seen,  in  the  anterior  view,  near  the  outer  part  of  the  base  of 
each  lung.  The  remainder  of  the  lung  seen  in  anterior  view 
is  formed  by  the  superior  and  middle  lobes  on  the  right  side 
and  the  superior  lobe  on  the  left  side  (Plates  XXVIII  and 
XXXII).  Posteriorly,  the  upper  third  is  formed  by  the 
superior  lobe  in  each  case,  while  the  remainder  is  formed  by 
the  inferior  lobe. 

The  internal  surface  of  each  lung,  which  also  extends 
from  apex  to  base,  is  shorter  and  more  irregular  in  contour 
than  the  external  surface.  It  is  concave  in  all  directions. 
The  concavity  is  more  marked  from  before  backwards  than 
from  above  downwards,  and  in  the  lower  two-thirds  than 
in  the  upper  third.  That  of  the  left  lung  is  much  more 
marked  than  the  right  (Plates  X,  XI,  XII,  XXVIII  and 
XXXII).  For  convenience  of  description  the  internal  sur- 
face of  each  lung  may  be  divided  into  four  areas.  The  first 
area  may  be  made  to  include  the  hilus,  the  second,  the 
region  above  the  hilus,  corresponding  to  the  superior  media- 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN         I9 

stinum,  the  third,  posterior  to  the  hilus,  corresponding  to 
the  posterior  mediastinum,  and  the  fourth,  anterior  to  the 
hilus,  corresponding  to  the  middle  and  anterior  media- 
stinum. 

The  hilus  is  an  area  roughly  oval  in  outline,  much 
nearer  the  posterior  than  the  anterior  part  of  the  middle 
of  the  inner  surface  of  the  lung,  through  which  the  root 
structures  pass  from  the  mediastinum  to  the  lung.  The 
root  of  the  right  lung  begins  above  at  a  plane  passed 
through  the  first  intercostal  space  and  the  lower  part  of  the 
fourth  thoracic  vertebra,  and  ends  below  at  a  plane  passed 
through  the  upper  part  of  the  fourth  sternochondral  articu- 
lation and  the  lower  border  of  the  seventh  thoracic  verte- 
bra. It  lies  between  the  vena  cava  superior  and  right  auri- 
cle anteriorly  and  the  vena  azygos  major  and  oesophagus 
posteriorly.  The  arrangement  of  the  three  main  structures 
forming  the  root,  from  above  downward  is  bronchus,  artery, 
vein.  The  arter}-  lies  in  a  plane  anterior  to  the  bronchus 
and  directly  over  the  vein.  The  vena  azygos  major  arches 
over  the  bronchus  and  empties  into  the  vena  cava  superior 
opposite  the  middle  of  the  fourth  thoracic  vertebra.  The 
root  is  covered  with  pleura  reflected  from  the  mediastinum 
onto  the  inner  surface  of  the  lung.  Anteriorly  the  reflection 
is  from  the  vena  cava  superior  to  the  pulmonary  artery 
above  and  from  the  pericardium,  at  the  level  of  the  auri- 
cula, to  the  pulmonary  vein  below.  Superiorly  the  pleura 
passes  from  the  side  of  the  trachea  over  the  right  bronchus 
onto  the  lung.  The  arch  of  the  vena  azygos  major  lies 
directly  under  the  pleura  covering  this  part  of  the  root. 
Posteriorly  the  reflection  is  from  the  vena  azygos  major, 
except  in  the  uppermost  part,  where  that  vein  lies  in  the 
posterior  part  of  the  root.  Here  the  reflection  is  from  the 
side  of  the  oesophagus.     Inferiorly  the  pleura  covering  the 


20  UNIVERSITY  OF  MISSOURI    STUDIES 

root  is  prolonged  downward  from  the  pulmonary  vein  to 
the  diaphragm,  forming  the  ligamentum  pulmonale  connect- 
ing the  inner  surface  of  the  lung  to  the  mediastinal  wall, 
(Plates  XI,  XII). 

The  hilus  of  the  left  lung  is  shorter  and  wider  than  that 
of  the  right  lung.  It  extends  from  the  lower  border  of  the 
fourth  to  the  lower  border  of  the  sixth  thoracic  vertebra.  The 
root  structures  are  in  relation  anteriorly  with  the  pericard- 
ium over  the  left  auricle,  and  posteriorly  with  the  descend- 
ing aorta  and  the  oesophagus. 

The  aorta  arches  over  the  root  of  the  left  lung  and  lies 
in  contact  with  the  bronchus  and  the  pulmonary  artery. 
The  bronchus,  artery,  and  vein  do  not  bear  the  same  relation 
to  each  other  as  in  the  root  of  the  right  lung.  The  bronchus 
is  above  at  first  but  in  its  downward  course  to  pass  under 
the  arch  of  the  aorta  it  also  passes  behind  and  below  the 
pulmonary  artery.  The  pulmonary  vein  lies  below  the 
artery  but  more  anterior  to  it  than  on  the  other  side.  On 
the  right  side  these  structures  are  bronchus,  artery,  vein, 
from  above  downward;  on  this  side  they  are  more  nearly 
bronchus,  artery,  vein,  from  before  backward.  On  account 
of  the  pleural  adhesions  of  this  lung,  it  is  difficult  to  deter- 
mine the  reflections  of  the  pleura  over  the  hilus. 

In  the  region  of  the  superior  mediastinum  the  right 
lung  is  in  relation  with  the  trachea  and  oesophagus,  and 
with  the  vena  cava  superior  from  its  formation  behind  the 
first  sternochondral  articulation  down  to  the  right  auricle. 
The  crista  pulmonis  projects  into  the  space  between  the 
oesophagus  and  the  vertebral  column.  The  vena  cava  su- 
perior makes  a  slight  impression  upon  the  lung  near  the  an- 
terior part  of  this  surface.  The  innominate  artery  is  in  rela- 
tion with  this  surface  of  the  lung  from  the  arch  of  the  aorta 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN        21 

up  to  where  its  subclavian  branch  arches  across  the  an- 
terior surface  of  the  lung.  The  phrenic  nerve  is  anterior 
to  the  lung  above  the  first  rib,  but  below  this  level  it  is  be- 
tween the  lung  and  the  vena  cava  superior.  The  vagus  is 
also  anterior  to  the  lung  above  but  at  the  sternoclavicular 
articulation  it  passes  inward  and  backward  between 
the  lung  and  the  trachea.  In  this  region  the  left  lung  is 
deeply  grooved  by  the  arch  of  the  aorta  below  and  the  sub- 
clavian artery  and  vertebral  vein  above.  The  groove  for 
the  subclavian  extends  from  that  for  the  aorta  upward  to 
the  subclavian  groove  across  the  anterior  surface  of  the 
apex.  The  crista  pulmonis  is  in  relation  in  this  region  with 
the  thoracic  duct  and  oesophagus  anteriorly  and  the  verte- 
bral column  posteriorly.  The  left  lung  does  not  enter  into 
close  relation  with  the  trachea  but  is  separated  from  it  above 
by  the  subclavian  artery,  and  the  oesophagus  which  lies  to 
the  left  of  the  midplane,  and  below  by  the  arch  of  the  aorta. 
The  vagus  and  phrenic  nerves  of  this  side  like  those  of  the 
right  side  are  at  first  anterior  to  the  lung  at  the  apex  but 
pass  internal  to  it  just  below.  On  both  sides  these  nerves 
pass  anterior  to  the  arch  of  the  subclavian.  The  left  vagus 
follows  the  anterior  surface  of  the  left  subclavian  artery 
down  to  the  arch  of  the  aorta,  the  left  side  of  which  it 
crosses  between  the  pleura  and  the  artery.  The  phrenic 
nerve  lies  anterior  to  the  vagus.  It  is  between  the  lung 
and  the  innominate  vein  above,  and  is  embedded  below,  in 
the  mediastinal  wall  about  half  way  from  the  sternum  to 
the  vertebral  column  (Plates  V,  VI,  and  VII). 

In  the  region  of  the  posterior  mediastinum  the  internal 
surface  of  the  inferior  lobe  of  each  lung  presents  a  slight 
impression.  The  vena  azygos  major  lies  in  the  impression 
in  the  right  lung.  The  descending  aorta  makes  the  im- 
pression in  the  left  lung.    This  impression  is  not  as  deep 


22  UNIVERSITY  OF  MISSOURI  STUDIES 

as  usual,  and  becomes  less  and  less  distinct  from  above 
downward.  The  oesophagus  which  lies  a  little  anterior  to 
these  vessels  is  in  contact  with  both  lungs.  It  is  partially- 
separated  from  the  left  lung  above  by  the  aorta,  but  below 
where  it  crosses  the  anterior  surface  of  the  aorta  it  is  in 
direct  contact  with  this  lung  (Plates  IX,  X,  XI,  and  XII). 
The  lungs  do  not  come  into  contact  with  the  thoracic  duct 
since  that  vessel  lies  between  the  vena  azygos  major  and  the 
aorta  and  behind  the   oesophagus. 

In  the  middle  and  anterior  mediastinal  regions  the  in- 
ternal surfaces  of  the  lungs  are  in  contact  with  the  heart. 
When  seen  in  anterior  projection  (Plates  XXVIII  and 
XXXII)  the  anterior  border  of  the  right  lung  overlaps  the 
right  border  of  the  heart  about  2  cm.,  while  the  anterior 
border  of  the  left  lung  overlaps  the  left  border  of  the  heart 
less  than  1  cm.  at  any  point.  All  three  lobes  of  the  right 
and  both  lobes  of  the  left  lung  touch  the  heart.  The  su- 
perior lobe  of  each  lung  is  the  only  part  in  contact  with 
the  basal  portion  of  the  heart  (Plates  VIII  and  IX).  These 
lobes  present  a  triangular  area  in  contact  with  the  heart 
which  may  be  bounded  below  by  a  line  from  the  lower 
part  of  the  sixth  thoracic  vertebra  to  the  middle  of  the 
fourth  sternochondral  articulation  on  the  right  side  and 
from  the  same  vertebra  to  the  sixth  costochondral  articula- 
tion on  the  left  side.  In  each  case  this  area  touches 
both  auricle  and  ventricle  and  on  the  left  side  the 
apex  of  the  heart  (Plates  VIII  to  XII).  The  middle 
lobe  of  the  right  lung  comes  into  contact  with  the  right 
auricle  near  its  upper  and  posterior  part  at  the  level  of  the 
disc  between  the  sixth  and  seventh  thoracic  vertebrae  and 
the  third  costal  cartilage.  The  area  covered  by  this  lobe 
increases  from  above  downward  as  that  covered  by  the 
superior  lobe  decreases.     At  the  level  of  the  fourth  car- 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN        23 

tilage  and  intercostal  space  it  covers  the  anterior  two- 
thirds  of  this  side  of  the  heart  (Plate  XI).  The  superior 
and  middle  lobes  of  the  right  lung  together  cover  an  area 
which  corresponds  very  closely  to  that  covered  by  the  su- 
perior lobe  of  the  left  lung.  The  inferior  lobe  of  each 
lung  comes  into  contact  with  the  posterior  part  of  the  left 
auricle  near  the  disc  between  the  sixth  and  seventh  thoracic 
vertebrae.  The  surface  of  each  of  these  lobes  in  contact 
with  the  heart  becomes  larger  and  larger  from  above  down- 
ward. This  is  especially  true  of  the  left  side  where  the 
heart  encroaches  more  and  more  upon  the  internal  surface 
of  this  lung  (Plates  XI  and  XII).  The  right  phrenic  nerve 
is  in  relation,  in  the  superior  mediastinum,  with  the  superior 
lobe.  About  the  level  of  the  third  costal  cartilage  it  crosses 
the  horizontal  fissure  and  comes  into  relation  with  the  mid- 
dle lobe,  which  it  crosses  obliquely  to  reach  the  inferior 
lobe  near  the  level  of  the  fourth  costal  cartilage.  It  re- 
mains in  contact  with  the  inferior  lobe  down  to  its  entrance 
into  the  diaphragm.  The  left  phrenic  is  only  in  contact 
with  the  superior  lobe  of  the  left  lung. 

The  base  of  each  lung  is  deeply  concave  in  all  direc- 
tions as  may  be  seen  from  the  height  to  which  the  dome 
of  the  diaphragm  rises  above  the  inferior  margin  of  each 
lung  (Plates  XXVIII  to  XXXV).  Its  margin  (margo  in- 
ferior) is  thin  except  internally,  where  it  rests  upon  the  cen- 
tral tendon  of  the  diaphragm.  The  anterior  part  of  the 
inferior  margin  of  each  lung  is  in  the  fifth  intercostal  space 
at  the  level  of  the  xiphosternal  articulation  and  the  disc 
between  the  ninth  and  tenth  thoracic  vertebrae.  The  in- 
ferior margin  of  the  right  lung  is  nearly  in  a  hori- 
zontal plane.  It  is  behind  the  sixth  right  sterno- 
chondral  articulation  at  the  sternum,  in  the  fifth  intercostal 


24  UNIVERSITY  OF   MISSOURI  STUDIES 

space  in  the  midclavicular  line,  at  the  upper  border  of  the 
seventh  rib  in  the  midaxillary  line,  and  over  the  head  of 
the  tenth  rib  at  the  side  of  the  vertebral  column.  The 
inferior  margin  of  the  left  lung  begins  anteriorly  in  the 
fifth  intercostal  space  near  the  midclavicular  line  and  passes 
behind  the  seventh  rib  in  the  midaxillary  line  to  end  in 
the  tenth  intercostal  space  at  the  side  of  the  vertebral 
column. 

The  base  of  the  right  lung  is  separated  by  the 
right  dome  of  the  diaphragm  from  the  right  lobe  of  the 
liver.  Since  the  middle  lobe  of  the  lung  forms  the  ante- 
rior part  of  the  base  it  enters  into  relation  with  a  corres- 
ponding portion  of  the  right  lobe  of  the  liver.  The  larger 
posterior  part  of  the  base  of  the  lung  is  formed  by  the  in- 
ferior lobe  which  is  in  relation  with  the  remainder  of  the 
superior  and  a  portion  of  the  posterior  surface  of  the  right 
lobe  of  the  liver.  The  inner  and  posterior  part  of  the  base 
is  in  relation  with  the  vena  cava  inferior  for  the  very  short 
distance  that  that  vessel  is  in  the  thoracic  cavity  between 
the  vena  caval  opening  through  the  diaphragm  and  that  into 
the  heart.  Below  the  caval  opening  through  the  diaphragm 
the  lung  is  separated  from  the  vena  cava  inferior  by  the 
diaphragm  (Plate  XIII).  The  projections  show  the  lung 
overlapping  the  liver  only  about  3  cm.  This  condition  is 
probably  due  to  the  lung  being  in  a  condition  of  extreme 
expiration.  During  inspiration  the  lung  margin  may  be 
pushed  down  into  the  costophrenic  sinus  several  centime- 
ters lower  than  is  found  in  this  subject. 

The  base  of  the  left  lung  is  in  relation  with  the  left 
lobe  of  the  liver,  the  stomach,  and  the  spleen.  The  liver 
extends  from  the  midline  of  the  body  outward  and  a  little 
backward,  filling  the  central  portion  of  the  left  dome  of 
the  diaphragm.     It  is  in  relation  with  the  central  portion 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN         25 

of  the  base  of  the  lung  which  is  formed  almost  entirely 
by  the  inferior  lobe  of  the  lung.  Since  the  inferior  mar- 
gin of  the  lung  is  below  the  level  of  the  liver  the  peripheral 
portion  of  the  base  comes  into  relation  with  the  fundus  of 
the  stomach  from  near  the  midclavicular  line  around  to 
the  vertebral  column  (Plates  XIII,  XXVIII  and  XXXII). 
The  upper  part  of  the  spleen  is  interposed  between  the 
posterior  part  of  the  base  of  the  lung  and  the  posterior  sur- 
face of  the  stomach  below  the  level  of  the  tenth  vertebra.  If 
the  base  of  the  lung  were  viewed  from  below,  its  gastric 
area  would  be  roughly  hourglass-shaped,  being  encroached 
upon  by  the  liver  from  the  front  and  right  side  and  by 
the  upper  pole  of  the  spleen  from  behind  and  the  left. 
Plates  XXVIII  and  XXXII  show  the  superior  lobe  of  the 
lung  (in  projection)  in  relation  with  the  spleen  but  a  ref- 
erence to  Plate  XIII  will  show  that  this  part  of  the  lung 
is  in  reality  separated  from  the  spleen  by  a  space  10  cm. 
in  width  containing  the  fundus  of  the  stomach. 

The  lungs  as  found  in  this  subject  do  not  reach  as  low 
a  level,  especially  upon  the  anterior  thoracic  wall,  as  is 
usually  given  in  works  on  topographic  anatomy.  This 
difference  is  probably  due  to  the  lungs  being  in  a  condi- 
tion of  extreme  expiration  in  this  instance  while  the  usual 
statements  apply  to  a  condition  which  is  a  mean  between 
expiration  and  inspiration. 

THE  TRACHEA 

The  trachea  begins  opposite  the  lower  part  of  the  sixth 
cervical  vertebra  and  bifurcates  in  front  of  the  disc  between 
the  fourth  and  fifth  thoracic  vertebrae.  Plates  XXVIII, 
XXIX,  XXXII  and  XXXIII  show  the  first  part  of  the 
trachea  to  the  left  of  the  midline,  while  Plate  III  shows  it 


26  UNIVERSITY  OF  MISSOURI  STUDIES 

apparently  to  the  right  of  the  midplane.  The  meas- 
urements were  made  to  the  right  and  left  of  a 
line  through  the  center  of  the  centrum  of  the  ver- 
tebra and  the  middle  of  the  interspace  between  the  hyoid 
muscles.  From  Plates  I,  II,  and  III  it  is  evident  that  the 
neck  is  rotated  to  the  right,  hence  the  deviation  from  the 
midplane.  Over  the  second  thoracic  vertebra  the  trachea 
is  divided  symmetrically  by  the  median  line,  but 
deviates  to  the  right  in  the  region  of  the  arch  of 
the  aorta  (Plate  VII).  It  rests  upon  the  oesophagus 
posteriorly  and  to  the  left.  It  is  in  relation  an- 
teriorly, above  the  sternum,  with  the  isthmus  of  the 
thyreoid  gland  and  sternothyreoid  muscles.  Below  the 
upper  border  of  the  sternum  the  trachea  is  crossed  by  the 
left  innominate  vein,  which  receives  near  the  midline  the 
inferior  thyreoid  veins.  At  about  this  same  level  the  in- 
nominate artery  is  in  contact  with  the  right  anterior  part 
of  the  trachea  separating  it  from  the  junction  of  the  in- 
nominate veins.  The  ascending  aorta  and  vena  cava  su- 
perior separate  the  remainder  of  the  trachea  from  the 
sternum.  In  the  region  of  the  seventh  cervical  and  the 
first  thoracic  vertebrae,  the  trachea  is  covered  laterally  by 
the  lateral  lobes  of  the  thyreoid.  At  the  lower  extremity 
of  the  thyreoid  the  trachea  comes  into  relation  laterally 
with  the  common  carotid  arteries.  The  left  carotid  runs 
nearly  parallel  with  the  trachea  down  to  the  arch  of  the 
aorta,  the  right  one  down  to  the  innominate  artery.  The 
lower  half  of  the  trachea  is  in  contact  laterally  with  the 
superior  lobe  of  the  right  lung  but  is  separated  from  the 
left  lung  by  the  oesophagus,  common  carotid  and  subclav- 
ian arteries  above  and  the  arch  of  the  aorta  below.  In  the 
upper  part  of  the  mediastinum  the  vagi  nerves  are  separ- 
ated from  the  trachea  by  the  carotid  arteries.     Below,  the 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN        27 

left  one  is  separated  from  the  trachea  by  the  aortic  arch, 
while  the  right  one  lies  between  the  trachea  and  the  lung 
(Plates  VI  and  VII).  The  right  recurrent  laryngeal  nerve 
does  not  come  into  close  relation  with  the  trachea.  The 
left  recurrent  lies  in  the  left  angle  between  the  oesopha- 
gus and  the  trachea  from  the  under  part  of  the  arch  of  the 
aorta  to  the  larynx. 

Mehnert^  places  the  bifurcation  of  the  trachea  opposite 
the  fifth  or  sixth  thoracic  vertebra  and  in  old  age  as  low 
as  the  seventh  vertebra. 

THE  HEART 

The  heart  is  seen  in  section  in  Plates  VIII  to  XII  and 
in  projection  in  Plates  XXVIII,  XXX,  XXXI,  XXXII, 
XXXIV  and  XXXV.  The  base  lies  between  the  second 
sternochondral  articulations  and  the  lower  half  of  the 
fifth  thoracic  vertebra.  The  apex  though  poorly  defined, 
may  be  located  behind  the  fifth  left  costochondral  articu- 
lation, about  7  cm.  from  the  midline,  at  the  level  of  the 
xiphosternal  articulation  and  the  lower  border  of  the  ninth 
thoracic  vertebra.  The  surface  form  of  the  heart  may  be 
seen  in  Plate  XXVIII.  The  base  is  represented  by  a  line 
through  the  middle  of  the  second  sternochondral  articula- 
tions. The  right  border  lies  entirely  to  the  right  of  the 
sternum  and  extends  from  the  lower  part  of  the  second  right 
costal  cartilage  near  the  sternum,  to  the  upper  border  of  the 
fifth  cartilage  about  3  cm.  from  the  midline.  Its  greatest  dis- 
tance to  the  right  of  the  midline  is  at  the  lower  end.  The 
inferior  border  extends  nearly  in  a  straight  line  from  the 
lower  end  of  the  right  border  to  the  apex  point.  It  crosses 
the  sternum  from  the  lower  part  of  the  fifth  right  to  the 

^Loc.  cit. 


28  UNIVERSITY    OF   MISSOURI  STUDIES 

lower  part  of  the  sixth  left  sternochondral  articulation. 
The  left  border  extends  upward,  with  a  marked  outward 
curve,  from  the  apex  point  to  the  middle  of  the  second 
left  costal  cartilage.  Its  greatest  distance  from  the  mid- 
line is  about  9  cm.  in  the  fourth  intercostal  space. 

The  outline  as  here  mapped  out  is  formed  by  all  four 
chambers  of  the  heart.  The  right  auricle  which  is  some- 
what distended,  forms  the  right  half  of  the  base,  the  entire 
right  border  and  a  small  portion  of  the  inferior  border. 
The  right  ventricle  forms  the  remainder  of  the  inferior  bor- 
der, with  the  exception  of  a  small  strip  near  the  apex  which 
is  formed  by  the  left  ventricle.  It  also  forms  the  left  half 
of  the  base  and  the  upper  portion  of  the  left  border,  where 
the  conus  arteriosus  rises  above  the  left  auricle.  The  left 
ventricle  forms  the  small  part  of  the  inferior  border  about 
the  apex  and  the  lower  two-thirds  of  the  left  border.  The 
left  auricle  forms  the  short  strip  between  the  left  ventricle 
and  the  conus  arteriosus  (Plate  XXXII). 

When  viewed  from  the  left  side  (Plates  XXXI  and 
XXXV)  the  main  part  of  the  heart  is  formed  by  the  left 
ventricle  with  the  left  auricle  above  and  behind  it.  The 
right  ventricle  forms  the  anterior  boundary  of  the  heart 
and  separates  the  left  ventricle  from  the  sternum.  The  up- 
per half  of  the  posterior  boundary  is  formed  by  the  left 
auricle  while  the  lower  half  is  formed  by  the  right  auricle, 
with  a  small  part  of  the  left  ventricle  near  the  apex  (Plates 
XI  and  XII). 

When  viewed  from  the  right  side  (Plates  XXX  and 
XXXIV)  the  larger  part  is  formed  by  the  right  auricle, 
with  the  right  ventricle  and  its  conus  arteriosus  forming 
the  anterior  boundary  and  the  left  auricle  forming  the  up- 
per half  of  the  posterior  boundary. 

The  positions  of  the  orifices  are  indicated  in  Plates 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN        29 

XXVIII,  XXX  and  XXXI.  The  tricuspid  orifice  is  some- 
what enlarged  on  account  of  the  distention  of  the  right 
auricle.  It  is  oblong  in  outline,  the  long  axis — superoin- 
ferior — being  about  4.5  cm.  and  the  short  axis  about 
3.5  cm.  in  length.  The  long  axis  coincides  roughly  with 
that  of  the  heart,  and  the  plane  of  the  orifice  forms  an 
angle  of  about  45  degrees  with  the  midplane  (Plates 
X  and  XI),  The  blood,  in  passing  from  the  auricle 
into  the  ventricle,  has  a  direction  forward,  to  the  left  and 
a  little  downward.  The  orifice  lies  beneath  the  left  half 
of  the  sternum  extending  from  .5  cm.  to  the  right  of  the 
midline,  to  the  left  border  of  the  sternum.  It  extends  from 
the  level  of  the  middle  of  the  third  to  the  upper  part  of  the 
fifth  sternochondral  articulation  or  from  the  level  of  the 
upper  border  of  the  seventh  to  the  lower  border  of  the 
eighth  thoracic  vertebra. 

The  pulmonary  orifice  is  behind  the  lower  part  of  the 
second  costal  cartilage  and  the  upper  half  of  the  second 
intercostal  space  at  the  left  margin  of  the  sternum.  The 
plane  of  the  orifice  forms  an  angle  of  about  45  degrees  with 
the  coronal  plane,  so  that  the  blood  in  passing  into  the 
pulmonary  artery  takes  a  direction  upward,  backward  and 
a  little  to  the  left.  The  orifice  is  guarded  by  three  semi- 
lunar valves,  one  of  which  is  anterior,  one  internal  and  one 
posterior. 

The  mitral  orifice  is  small  and  relatively  wider  than 
the  tricuspid.  Its  long  axis  is  nearly  vertical,  being  about 
4  cm.  in  length,  while  its  short  axis  is  about  3.5  cm.  in  length 
The  blood  takes  a  direction  downward,  forward  and  to  the 
left  in  passing  from  the  auricle  into  the  ventricle.  This 
orifice  is  located  almost  entirely  to  the  left  of  the  sternum 
behind  the  third  costal  cartilage,  third  intercostal  space, 
and  upper  half  of  the  fourth  costal  cartilage  at  the  level  of 


3©  UNIVERSITY  OF  MISSOURI  STUDIES 

the  seventh  thoracic  vertebra.  Its  center  is  about  1.5  cm. 
above,  3.5  cm.  behind  and  2  cm.  to  the  left  of  the  center  of 
the  tricuspid  orifice. 

The  aortic  orifice  lies  behind  the  left  half  of  the  ster- 
num at  the  level  of  the  upper  border  of  the  third  costal 
cartilage  and  opposite  the  middle  of  the  sixth  thoracic 
vertebra.  The  plane  of  this  orifice  is  more  nearly  hor- 
izontal than  that  of  any  of  the  other  openings.  It  is 
about  2  cm.  below  and  2  cm.  internal  to  the  pulmonary 
orifice.  The  blood  in  passing  into  the  aorta  takes  a  direc- 
tion upward,  to  the  right  and  a  little  backward.  The  semi- 
lunar valves  which  guard  the  opening  are  one  anterior  and 
two  posterior.  The  mesial  posterior  cusp  is  a  little  more 
anteriorly  placed  than  the  lateral  (Plate  IX). 

The  heart  enters  into  relations  with  the  surrounding 
organs  through  the  pericardium  which  surrounds  it  and 
which  will  be  considered  as  a  part  of  the  heart  in  this 
paragraph.  The  right  auricle  is  separated  from  the  ante- 
rior thoracic  wall  by  the  thin  anterior  part  of  the  right 
lung.  The  right  ventricle  is  in  contact  for  the  most  part 
with  the  gladiolus  throughout  the  entire  extent  of  that 
bone,  and  with  the  second,  third,  fourth  and  fifth  left  costal 
cartilages  and  the  intercostal  muscles.  Nearly  half  of  the 
narrow  strip  of  the  left  ventricle  seen  in  the  anterior  pro- 
jection is  in  direct  contact  with  the  ribs  and  intercostal 
muscles.  The  remainder  of  the  ventricle  together  with  the 
left  auricle,  is  covered  anteriorly  by  the  anterior  part  of 
the  left  lung.  Thus  the  greater  part  of  the  anterior  sur- 
face of  the  heart  is  not  covered  by  the  lungs.  This  un- 
covered area  which  is  about  10  cm.  wide  across  at  the  fourth 
ribs  is  to  be  explained  by  the  extreme  contraction  of  the 
lungs  and  accompanying  distention  of  the  right  auricle 
(Plates  X  and  XI)  and  by  the  exclusion  of  the  left  lung 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN        3 I 

from  that  part  of  the  pleural  cavity  lying  between  the  heart 
and  the  anterior  thoracic  wall  by  the  adhesions  of  the  me- 
diastinal and  costal  pleurae. 

Laterally  the  heart  is  in  immediate  contact  with  the 
anterior  part  of  the  internal  surface  of  each  lung.  The 
right  side  of  the  heart  may  be  divided  into  three  areas  each 
of  which  runs  from  above  downward  and  forward  and  cor- 
responds to  one  of  the  three  lobes  of  the  right  lung.  The 
upper  area  includes  roughly  the  right  auricula,  and  the  conus 
arteriosus  and  is  in  relation  with  the  superior  lobe  of  the 
lung.  The  middle  area  includes  the  remainder  of  the  right 
ventricle  and  the  right  auricle  except  the  posteroinfe- 
rior  part  near  the  opening  of  the  vena  cava  inferior.  It 
corresponds  to  the  middle  lobe  of  the  lung.  The  lower 
area,  which  corresponds  to  the  inferior  lobe  of  the  lung  is 
small  and  includes  a  part  of  each  auricle  (Plates  X,  XI  and 
XII). 

The  left  surface  of  the  heart  may  be  divided  in  the 
same  way  into  two  areas,  which  correspond  to  the  two 
lobes  of  the  left  lung.  The  upper  area  is  the  larger  and  in- 
cludes the  right  ventricle,  most  of  the  left  ventricle,  and 
the  superior  and  anterior  part  of  the  left  auricle.  This 
area  corresponds  very  closely  to  the  upper  and  middle 
areas  of  the  right  side.  The  lower  area  is  a  continuation 
outward  of  that  part  of  the  posterior  surface  of  the  heart 
in  relation  with  the  inferior  lobe  of  the  left  lung.  It  in- 
cludes the  greater  part  of  the  left  auricle  and  the  postero- 
inferior  part  of  the  left  ventricle. 

The  base  of  the  heart  is  in  relation  with  the  great  ves- 
sels which  arise  from  it  and  with  the  large  mediastinal 
lymph  glands  seen  in  Plate  VII. 

The  heart  is  in  relation,  posteriorly,  near  the  base, 
with  the  roots  of  the  lungs.    Below  the  roots  of  the  lungs 


32  UNIVERSITY  OF  MISSOURI  STUDIES 

it  is  in  contact  with  the  oesophagus  and  descending  aorta. 
A  small  part  of  the  internal  surface  of  each  lung  reaches  the 
heart  external  to  the  oesophagus  and  aorta  (Plates  VIII 
and  IX).  Below  the  disc  between  the  seventh  and  eighth 
thoracic  vertebrae,  the  aorta  is  separated  from  the  heart  by 
the  left  half  of  the  oesophagus.  From  above  downward, 
more  and  more  of  the  posterior  surface  of  the  heart  is  cov- 
ered by  the  inferior  lobe  of  the  left  lung. 

Inferiorly,  the  right  auricle  and  internal  part  of  the 
right  ventricle  rest  upon  the  central  tendon  of  the  dia- 
phragm, while  the  remainder  of  the  right  ventricle  and 
the  left  ventricle  rest  upon  the  internal  muscular  portion 
of  the  left  dome.  These  portions  of  the  heart  are  in  rela- 
tion through  the  diaphragm  with  the  left  lobe  of  the  liver. 
They  lie  on  a  line  which  runs  outward,  forward 
and  slightly  downward  from  the  disc  between  the  eighth 
and  ninth  vertebrae  to  the  anterior  extremity  of  the 
left  fifth  rib.  From  Plates  XXVIII  and  XXXII  it 
appears  that  the  heart  is  in  relation  with  the  fundus  of 
the  stomach,  but  Plate  XIII  shows  that  the  lower  part  of 
the  pericardial  cavity  is  separated  from  the  stomach  by  the 
left  lobe  of  the  liver.  The  apparent  intimate  relation  be- 
tween the  apex  of  the  heart  and  the  upper  pole  of  the  spleen 
is  of  the  same  nature  (Plates  XIII,  XXXI  and  XXXV). 

The  position  and  relations  of  the  heart  in  this  cadaver 
differ  somewhat  from  those  given  in  many  topographic 
anatomies.  Cunningham^  gives  photographs  of  formalin 
hardened  bodies,  with  the  heart  exposed,  which  show  the 
heart  to  be  about  2  cm.  lower  on  the  anterior  wall,  than  in 
these  projections.    Quain'  gives  practically  the  same  posi- 

^  Loc.  cit. 

^Thane,  G.  D.,  Quain's  Elements  of  anatomy.  Angeiology,  II.  ii. 
London,  1896. 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN        33 

tion  as  Cunningham.  Joessel'  gives  the  same  position  for 
the  heart  but  differs  as  to  the  location  of  the  orifices.  He 
places  the  tricuspid,  pulmonary  and  aortic  orifices  lower 
than  they,  but  the  mitral  as  high  or  higher  than  found  in 
this  case.  Hermann  and  Ruedel*  project  the  heart  at  a 
higher  level  upon  the  ribs  of  the  anterior  wall  of  the  tho- 
rax, but  in  their  table  of  levels  place  it  lower  upon  the  ver- 
tebral column  than  found  here.  The  valves  are  lower  and 
the  planes  of  the  tricuspid  and  mitral  are  more  oblique  in 
their  subject.  Henke"  and  Toldt'  also  place  the  heart  at  a 
lower  level.  Deaver^  and  Merkef  locate  it  at  nearly  the 
same  level  as  found  here,  but  place  the  orifices  differently. 
Deaver  finds  them  lower  and  Merkel  higher  than  here. 
Both  however  place  the  tricuspid  orifice  in  a  more  oblique 
position  with  more  of  it  to  the  right  of  the  midplane  than 
shown  in  Plate  XXVIH.  The  heart  in  this  subject  is 
more  horizontally  placed  with  its  valves  more  vertical  than 
in  any  of  the  cases  referred  to  above.  The  arch  of  the 
aorta  is  also  higher  than  is  given  in  any  of  the  above 
works.  The  fact  that  the  apex  of  the  heart  seems  to  be 
high  would  lead  one  to  think  that  the  apical  portion  has 
been  raised,  thus  making  the  inferior  border  nearly  hor- 
izontal and  rotating  the  valve  areas  into  a  more  vertical  di- 
rection.    The  lower    part  of  the  margin  of  the  tricuspid 

^Joessel,  G.,  Lehrbuch  der  topographisch-chirurgischen  anatomie. 
Bonn,  1899. 

*  Loc.  cit. 

*Henke,  W.,  Construction  der  lage  des  herzens  in  der  leiche. 
Tlibingen,  1883. 

^ Toldt,  C,  Anatomischer  atlas.     2  Aufl.     Berlin  und  Wien,  1900. 
^Deaver,  J.  B.,  Surgical  anatomj.     Philadelphia,   1S99-1903. 
8  Merkel.  F.,    Handbuch  der  topographischen  anatomie.     Braunsch- 
weig, 1885- 1899. 
3 


34 


UNIVERSITY   OF  MISSOURI   STUDIES 


orifice  may  have  been  pushed  to  the  left  by  the  distention 
of  the  lower  part  of  the  right  auricle  (Plates  X  and  XI). 
In  this  connection  it  will  be  noted  that  the  left  dome  of 
the  diaphragm  is  at  nearly  the  same  height  as  the  right 
one.  It  is  possible  that  the  adhesions  of  the  left  lung  to 
the  pericardium  and  diaphragm,  the  moderate  distention  of 
the  stomach  and  the  intraperitonaeal  injection  may  have 
raised  the  left  dome  of  the  diaphragm  and  carried  the 
apical  portion  of  the  heart  upward  to  a  position  higher 
than  it  originally  occupied.  However,  it  is  not  probable 
that  these  factors  will  account  for  the  base  of  the  heart 
and  the  arch  of  aorta  being  higher  than  usual. 

AORTA  AND  VENAE  CAVAE 

The  aorta  lies  entirely  to  the  left  of  the  midplane  at 
its  origin  from  the  left  ventricle  behind  the  third  left  ster- 
nochondral  articulation.  The  ascending  aorta  inclines  to 
the  right  as  it  goes  upward  so  that  the  base  of  the  innom- 
inate artery  is  to  the  right  of  the  midplane  behind  the  first 
sternochondral  articulation.  The  aortic  arch  lies  behind 
the  left  half  of  the  manubrium  at  the  level  of  the  disc  be- 
tween the  third  and  fourth  thoracic  vertebrae,  and  the  up- 
per half  of  the  fourth  vertebra.  Its  highest  point  is  less 
than  1  cm.  below  the  upper  border  of  the  sternum.  The 
artery  reaches  the  left  side  of  the  vertebral  column  at  the 
level  of  the  fifth  vertebra  and  remains  in  close  relation 
with  the  left  anterior  aspect  of  the  vertebral  column  down 
to  the  point  of  bifurcation  over  the  disc  between  the  third 
and  fourth  lumbar  vertebrae  (Plates  VIII  to  XIX  and 
XXVIII,  XXIX,  XXXI,  XXXII,  XXXIII  and  XXXV). 

At  its  origin  the  aorta  is  in  contact  with  the  conus 
arteriosus  anteriorly,  with  the  left  auricula  and  auricle  to 
the  left  and  posteriorly,  and  with  the  right  auricle  to  the 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN         35 

right  (Plate  IX).  A  little  higher  up,  at  the  level  of  the 
fifth  vertebra  (Plate  VIII),  the  left  auricula  has  been  re- 
placed by  the  pulmonary  artery,  the  left  auricle  by  the 
right  branch  of  the  pulmonary  artery,  and  the  right  auri- 
cle by  the  right  auricula  and  vena  cava  superior.  The 
remainder  of  the  ascending  aorta  and  the  aortic  arch  are 
separated  from  the  sternum  and  the  left  lung  by  large  me- 
diastinal lymph  glands.  The  vena  cava  lies  to  the  right 
of  the  ascending  limb  of  the  arch  and  is  separated  from  it 
by  the  pericardium  only  (Plate  VIII).  The  arch  of  the 
aorta  is  fitted  closely  around  the  left  side  of  the  trachea. 
The  descending  aorta  is  between  the  trachea  and  oesopha- 
gus internally  and  the  internal  surface  of  the  left  lung  ex- 
ternally. The  left  bronchus  passes  under  the  arch  of  the 
aorta  in  contact  with  its  concave  surface  and  separates  the 
descending  limb  from  the  pulmonary  artery  and  the  upper 
part  of  the  left  auricle.  At  the  level  of  the  fifth  thoracic 
vertebra  the  oesophagus  lies  to  the  right  of  the  aorta.  It 
becomes  gradually  anterior  to  the  aorta  and  crosses  the 
artery  in  front  of  the  ninth  vertebra  to  reach  the  cardia 
of  the  stomach.  The  aorta  makes  a  slight  groove  in  the 
left  lung  posterior  to  the  hilus  but  does  not  make  an  im- 
pression upon  the  lung  near  the  base.  The  crura  of  the 
diaphragm  cover  the  artery  from  the  upper  part  of  the 
tenth  thoracic  to  the  middle  of  the  first  lumbar  vertebra, 
where  the  aorta  pierces  the  diaphragm  and  comes  into  re- 
lation with  the  posterior  surface  of  the  pancreas.  Just  be- 
low the  inferior  border  of  the  pancreas  the  artery  is  crossed 
by  the  left  renal  vein.  At  the  level  of  the  second  lumbar  ver- 
tebra the  aorta  passes  behind  the  transverse  portion  of  the 
duodenum.  Below  the  duodenum  the  radix  of  the  mesen- 
tery is  attached  to  the  posterior  body  wall  over  the  aorta. 
From  the  arch  to  the  disc    between  the  first  and    second 


36  UNIVERSITY  OF  MISSOURI  STUDIES 

lumbar  vertebrae,  the  thoracic  duct  lies  along  the  right 
side  of  the  aorta.  The  two  vessels  pierce  the  diaphragm 
together.  The  cisterna  chyli  lies  to  the  left  of  the  aorta 
over  the  second  lumbar  vertebra.  The  thoracic  duct  lies 
between  the  aorta  and  the  vena  azygos  major.  The  aorta 
and  vena  cava  inferior  are  separated  near  the  heart  by  the 
oesophagus.  After  the  oesophagus  enters  the  stomach  the 
vessels  are  separated  by  the  right  crus  of  the  diaphragm, 
down  to  the  aortic  opening  of  the  diaphragm.  The  last 
5  cm.  of  the  aorta  are  in  direct  relation  with  the  left  side  of 
the  vein.  The  left  vagus  nerve  lies  upon  the  anteroex- 
ternal  part  of  the  aorta  down  to  the  diaphragm.  Its  re- 
current laryngeal  branch  passes  between  the  bronchus  and 
the  under  surface  of  the  arch  on  its  way  back  to  the  larynx. 

The  vena  cava  superior  is  formed  behind  the  right 
border  of  the  manubrium  at  the  level  of  the  first  sterno- 
chondral  articulation.  It  descends  nearly  vertically  down- 
ward to  empty  into  the  right  auricle  at  the  level  of  the 
second  intercostal  space  and  the  lower  part  of  the  fifth  thor- 
acic vertebra.  It  lies  between  the  ascending  aorta  and  the 
anterior  part  of  the  internal  surface  of  the  right  lung.  It 
is  separated  from  the  sternum  by  the  lung,  and  passes  be- 
hind the  right  auricula  just  before  entering  the  heart.  Be- 
hind the  upper  part  of  the  vena  cava  superior  is  the  trachea 
and  behind  the  lower  part,  the  right  branch  of  the  pulmo- 
nary artery.  The  right  phrenic  nerve:  runs  between  it  and 
the  pleura. 

The  vena  cava  inferior  is  formed  in  front  of  the  lower 
part  of  the  fourth  lumbar  vertebra  a  little  to  the  right  of 
the  midplane  and  empties  into  the  posteroinferior  part  of 
the  right  auricle  (Plate  XII)  at  the  level  of  the  disc  between 
the  eighth  and  ninth  thoracic  vertebrae.  The  opening,  into 
the  heart,  of  the  vena  cava  inferior  is  vertically  under  that 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN        37 

of  the  vena  cava  superior,  and  is  also  somewhat  larger. 
At  its  origin  the  vein  rests  upon  the  anterior  surface  of 
the  vertebral  column  and  the  right  psoas  major  muscle. 
Over  the  second  and  first  lumbar  vertebrae,  the  right  crus 
separates  it  from  the  vertebral  column.  From  this  level 
up  to  where  it  pierces  the  diaphragm  it  is  separated  from  the 
centra  by  the  lumbar  portion  of  the  diaphragm.  It  is 
crossed  anteriorly  by  the  third  portion  of  the  duodenum 
and  the  head  of  the  pancreas  and  lies  just  internal  to  the 
first  and  second  portions  of  the  duodenum,  and  anteroin- 
ternal  to  the  right  kidney,  from  which  it  is  separated  by 
the  suprarenal  gland.  Above  the  level  of  these  structures 
it  is  embedded  in  the  posterior  surface  of  the  liver  be- 
tween the  right  and  Spigelian  lobes. 

THE  OESOPHAGUS 

The  oesophagus  begins  at  the  lower  part  of  the  sixth 
cervical  vertebra  and  ends  opposite  the  upper  half  of  the 
tenth  thoracic  vertebra.  It  lies  just  anterior  to  the  ver- 
tebral column  near  the  midplane  of  the  body.  In  the  region 
of  the  last  cervical  and  the  first  three  thoracic  vertebrae 
more  than  half  of  the  oesophagus  is  to  the  left  of  the  mid- 
plane.  Over  the  fourth  and  fifth  vertebrae  it  is  pushed  to 
the  right  of  the  midplane  by  the  arch  of  the  aorta.  In  the 
remainder  of  its  course  it  deviates  to  the  left  and  crosses 
the  anterior  surface  of  the  aorta  in  front  of  the  ninth  ver- 
tebra. It  pierces  the  diaphragm  at  this  level  and  enters 
the  cardiac  portion  of  the  stomach  to  the  left  of  the 
tenth  vertebra.  Above  the  root  of  the  lung  it  lies  be- 
tween the  trachea  and  the  vertebral  column,  with  both  of 
which  it  is  in  contact.  It  is  in  relation  by  its  lateral  sur- 
faces above  with  the  lateral  lobes  of    the    thyreoid    gland 


38  UNIVERSITY  OF  MISSOURI  STUDIES 

and  below  with  the  posterior  part  of  the  internal  surface 
of  each  lung.  The  arch  of  the  aorta  separates  it  from  the 
left  lung  at  the  level  of  the  fourth  vertebra.  At  the  level 
of  the  fifth  thoracic  vertebra  it  is  separated  from  the  pul- 
monary artery  by  the  bronchi  and  large  bronchial  lymph 
glands.  At  this  same  level  the  aorta  lies  to  its  left,  the  cen- 
trum of  the  vertebra  behind  it,  and  the  vena  azygos  major 
to  its  right.  Below  this  level  it  is  separated  from  the  verte- 
bral column  by  the  vena  azygos  major,  the  thoracic  duct 
and  the  aorta,  and  is  in  contact  anteriorly  with  the  pos- 
terior surface  of  the  heart  down  to  the  diaphragm.  Be- 
low this  it  is  in  contact  with  the  tuber  omentale  of  the 
left  lobe  of  the  liver.  It  is  in  contact  with  the  lung  on 
either  side  in  the  region  where  it  is  anterior  to  the  aorta 
and  vena  azygos  major.  The  thoracic  duct  lies  behind 
the  oesophagus  below  the  fourth  thoracic  vertebra,  but 
crosses  its  left  side  and  lies  anteroexternal  to  it  above  the 
second  thoracic  vertebra. 

"        '  STOMACH 

The  stomach  lies  in  the  left  hypochondriac  and  epigas- 
tric regions.  The  fundus  lies  behind  the  left  costal  arch, 
and,  in  the  midclavicular  line,  rises  to  the  fifth  rib  on  a 
level  with  the  sixth  sternochondral  articulation.  The  car- 
diac orifice  lies  in  the  midaxillary  plane  about  2  cm.  to 
the  left  of  the  midplane  at  the  side  of  the  upper  half  of  the 
tenth  thoracic  vertebra,  behind  the  sixth  and  seventh  left 
costal  cartilages  near  their  junction  with  the  sternum. 
The  pyloric  orifice  is  about  4  cm.  to  the  right  of  the  mid- 
plane  at  the  level  of  the  first  lumbar  vertebra.  It  is  about  5 
cm.  in  front  of,  G  cm.  to  the  right  of,  and  7  cm.  below  the 
cardiac  orifice.    The  lesser  curvature,  which  is  a  direct  con- 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN         39 

tiiiuation  of  the  right  side  of  the  oesophagus,  lies  to  the 
left  of  the  midplane  at  the  eleventh  vertebra  and  to  the  right 
at  the  twelfth  vertebra.  It  is  under  cover  of  the  inferior 
surface  of  the  liver.  The  greater  curvature  of  the  stomach, 
which  is  a  continuation  of  the  left  side  of  the  oesophagus, 
passes  upward  and  outward  from  the  cardia  under  the  fifth 
rib  below  the  left  dome  of  the  diaphragm.  It  comes  down- 
ward under  the  seventh  rib,  leaves  the  costal  arch  under 
the  tenth  costal  cartilage,  crosses  the  midplane  at  the  upper 
part  of  the  first  lumbar  vertebra  and  ends  at  the  outer  part 
of  the  pylorus  just  internal  to  the  end  of  the  right  ninth 
cartilage.  It  lies  in  direct  contact  with  the  diaphragm  and 
the  anterior  abdominal  wall  through  the  greater  part  of  its 
course. 

The  anterior  surface  of  the  fundus  and  the  body  are 
in  contact  with  the  inferior  surface  of  the  left  lobe  of  the 
liver,  the  diaphragm  and  anterior  abdominal  wall.  The 
anterior  border  of  the  left  lobe  of  the  liver  is  relatively 
high  so  that  the  stomach  comes  into  direct  contact  below 
the  liver  with  the  anterior  abdominal  wall  internal  to  the 
costal  arch  and  with  the  diaphragm  external  to  the  costal 
arch.  That  part  of  the  anterior  surface  of  the  pyloric  por- 
tion lying  to  the  left  of  the  midplane  is  in  contact  with  the 
internal  part  of  the  inferior  surface  of  the  left  lobe,  but  that 
part  lying  to  the  right  of  the  midplane  is  in  contact  with  the 
inferior  surface  of  the  quadrate  lobe  and  the  peritonaea! 
surface  of  the  fundus  of  the  gall  bladder  (Plates  XVI  and 

XVII). 

The  posterior  surface  of  the  stomach  is  in  contact  with 
the  spleen  which  separates  it  from  the  diaphragm  and  base 
of  the  lungs  below  the  level  of  the  tenth  thoracic  vertebra. 
(See  relations  of  lung  to  stomach.)  The  internal  part  of 
the  posterior  surface  of    the    stomach    is    attached    to    the 


40  UNIVERSITY  OF  MISSOURI  STUDIES 

diaphragm  above  the  disc  between  the  eleventh  and 
twelfth  vertebrae,  but  below  this  level  they  are  separated 
by  the  lienal  recess  of  the  lesser  peritonaeal  cavity.  This 
peritonaeal  portion  of  the  posterior  surface  of  the  stomach 
is  in  relation  with  the  pancreas,  suprarenal  gland,  kidney 
and  spleen.  The  superior  border  of  the  pancreas  crosses 
the  lower  part  of  the  stomach  and  separates  it  from  a  part 
of  the  suprarenal  gland,  kidney  and  spleen.  (Plates  XVI, 
XXVIII  and  XXXII.)  Its  anterior  surface  lies  imme'- 
diately  below  this  part  of  the  stomach.  The  upper  half  of 
the  suprarenal  gland,  lies  between  the  stomach  and  the  verte- 
bral column  and  the  medial  border  of  the  kidney.  Postero- 
external to  the  suprarenal  area,  also  above  the  upper 
boundary  of  the  pancreas,  the  upper  pole  of  the  kidney  is  in 
contact  with  the  stomach.  This  area  is  bounded  inferiorly 
by  the  pancreas,  internally  by  the  suprarenal  gland,  super- 
iorly by  the  upper  limit  of  the  kidney  between  the  suprarenal 
gland  and  the  spleen,  and  externally  by  the  spleen  (Plates 
XXVIII  and  XXXII). 

The  pyloric  portion  of  the  stomach  is  in  relation  pos- 
teriorly with  the  neck  and  head  of  the  pancreas,  the  hepa- 
toduodenal ligament  and  the  first  portion  of  the  duodenum. 
The  greater  curvature  is  bound  closely  to  the  transverse 
colon  by  th^  great  omentum. 

Cunningham,  Addison^  and  Ruedinger,^  place  the  car- 
diac orifice  higher  than  found  in  this  subject.  Merkel  places 
it  at  the  level  of  the  eleventh  thoracic  vertebra,  which  is 
several  centimeters  lower  than  most  anatomists  locate  it. 
The  difference  seems  to  be  more  in  its  relation  to  the  verte- 

^  Addison,  C,  On  the  topographical  anatomy  of  the  abdominal 
viscera  in  man.  Journal  of  anat.  &  physiol.,  JXXXIII,  XXXIV  and 
XXXV. 

2  Riidinger,  A.,  Cursus  der  topographischen  anatomic.  Miinchen, 
1S99. 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN        4 1 

bral  column  than  to  the  anterior  wall,  since  nearly  every 
anatomist  locates  it  near  the  seventh  left  sternochondral 
articulation.  The  pylorus  in  this  subject  is  lower  and  fur- 
ther from  the  midplane  than  the  above  mentioned  anat- 
omists place  it,  but  when  it  is  remembered  that  the  pylorus 
moves  downward  and  to  the  rig-ht  as  the  stomach  is  filled 
and  that  the  stomach  was  moderately  distended  in  this  case, 
it  will  appear  that  the,  position  of  the  pylorus  as  shown  in 
these  plates  agrees  more  or  less  closely  with  the  usual  con- 
dition. 

DUODENUM  ANID  JEJUNOILEUM 

The  duodenum  is  seen  in  Plates  XVII  and  XVIII. 
It  begins  at  the  pylorus  opposite  the  first  lumbar  vertebra, 
rises  about  1  cm.  and  turns  backward  and  downward  and 
runs  by  the  side  of  the  vertebral  column  as  far  as  the  disc 
between  the  second  and  third  vertebrae.  In  its  course  up- 
ward and  to  the  left  it  crosses  the  vertebral  column  oppo- 
site the  lower  half  of  the  second  and  the  upper  half  of  the 
third  lumbar  vertebrae  and  ends  about  5  cm.  to  the  left  of 
the  midline  opposite  the  first  lumbar  vertebra.  The  organ 
when  viewed  from  the  front  (Plates  XXVIII  and  XXXII) 
is  roughly  U-shaped  with  the  right  limb  of  the  U  nearly 
vertical,  the  two  ends  at  about  the  same  level  and  about 
10  cm.  apart.  The  lowest  point  of  the  U  is  in  front  of  and 
a  little  to  the  right  of  the  middle  of  the  third  lumbar  ver- 
tebra. 

The  first  portion  lies  between  the  liver  externally,  the 
head  of  the  pancreas  internally,  the  pylorus  anteriorly  and 
the  kidney,  suprarenal  gland  and  vena  cava  inferior  poster- 
iorly. (Plate  XVII).  Above  it,  is  the  inferior  surface  of  the 
right  lobe  of  the  liver,  to  which  it  is  bound  by  the  hepatodu- 


42  UNIVERSITY   OF  MISSOURI  STUDIES 

odenal  ligament,  containing  the  root  structures  of  the  liver. 
The  second  portion  is  bound  to  the  inner  part  of  the  an- 
terior surface  of  the  right  kidney  as  far  down  as  the  lower 
margin  of  the  hilus.  For  a  very  short  space  below  the  hilus 
the  duodenum  is  internal  to  the  kidney  and  rests  upon  the 
psoas  major  muscle  and  the  ureter.  Internally  this  second 
portion  is  attached  to  the  vena  cava  inferior  behind  and  the 
head  of  the  pancreas  in  front.  Anteriorly  it  is  in  relation  to 
the  antrum  pyloricum  and  the  beginning  of  the  transverse 
colon.  Externally  it  is  in  contact  with  the  inferior  surface 
of  the  liver  above,  and  is  attached  to  the  hepatic  flexure  below 
(Plates  XVII  and  XVIII).  The  third  or  transverse  por- 
tion lies  upon  the  vena  cava  inferior  and  aorta  in  front  of 
the  second  and  third  vertebrae,  and  behind  the  lower  part 
of  the  head  of  the  pancreas  which  projects  downward  into 
the  base  of  the  mesentery  attached  to  this  part  of  the 
duodenum.  The  anterior  surface  of  this  transverse  portion 
is  crossed  by  the  mesenteric  vessels,  and  the  large  lymph 
glands  which  accompany  them.  The  fourth  portion  of  the 
duodenum  is  bound  to  the  aorta,  receptaculum  chyli  and 
left  renal  vessels  posteriorly,  and  has  the  radix  of  the 
mesentery  attached  to  it  anteriorly.  The  head  and  neck 
of  the  pancreas  are  attached  to  the  internal  surface  while 
the  body  of  the  pancreas  passes  outward  above  and  behind 
the  duodenojejunal  angle.  The  lateral  and  anterior  sur- 
faces of  this  portion  are  in  relation  with  coils  of  the 
jejunoileum. 

The  duodenum  in  this  case  corresponds  closely  with 
Schieflferdecker's^  second  position  of  the  duodenum.  How- 
ever in  the  case  of  his  figure  as  in  the  location  given  by 

^  Schiefferdecker,  P.,  Beitrage  zur  topographie  des  darmes. 
Archiv  fiir  anatomie  und  entwickelungsgeschichte.  i8S6.  Plate  XVI, 
iig.  2. 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN        43 

most  anatomists  the  duodenojejunal  angle  is  at  the  level 
of  the  second  instead  of  the  first  lumbar  vertebra.  Jon- 
nesco-  places  the  transverse  portion  across  the  fourth  or 
fifth  lumbar  vertebra  and  the  pylorus  and  duodenojejunal 
ang-le  at  the  side  of  the  first  lumbar  vertebra. 

The  jejunoileum  begins  at  the  duodenojejunal  angle 
about  5  cm.  to  the  left  of  the  midplane  at  the  level  of  the 
first  lumbar  vertebra,  and  ends  at  the  ileocolic  valve  about 
3  cm.  to  the  right  of  the  midplane  over  the  right  end  of  the 
disc  between  the  fourth  and  fifth  lumbar  vertebrae.  The 
coils  of  this  part  of  the  intestine  are  so  variable  in  position 
and  relations  that  they  are  not  represented  in  the  projec- 
tions. The  mesentery  is  attached  to  the  posterior  body 
wall  along  a  line  nearly  straight  from  the  duodenojejunal 
angle  to  the  ileocolic  valve.  In  the  upper  half  this  attach- 
ment is  to  the  front  of  the  fourth  portion  of  the  duodenum. 
In  the  lower  half  it  is  at  first  attached  to  the  aorta,  then  to 
the  vena  cava  inferior  and  right  common  iliac  vessels. 

THE  LARGE  INTESTINE 

The  caecum  lies  in  the  right  iliac  fossa  and  extends  as 
far  down  as  the  promontory  of  the  sacrum.  Its  apex  is 
about  4  cm.  below  the  ileocolic  valve.  The  latter  is  anterior 
and  to  the  right  of  the  disc  between  the  fourth  and  fifth 
lumbar  vertebrae,  about  1  cm.  below  a  line  connecting  the 
highest  points  of  the  crests  of  the  ilia  and  3  or  4  cm.  above 
a  line  connecting  the  anterior  superior  iliac  spines. 

The  vermiform  appendix  arises  from  the  posterior  part 
of  the  internal  surface  of  the  caecum  about  midway  between 
the  ileocolic  valve  and  the  apex  of  the  caecum,  and  extends 

2Jonnesco,  T.,  Poirier,  P.  et  Charpj,A.,  Traits  d' anatomic  humaine, 
IV. 


44  UNIVERSITY  OF  MISSOURI  STUDIES 

inward  anterior  to  the  right  half  of  the  fifth  vertebra.  It 
lies  internal  to  the  caecum  and  is  connected  to  the  intestine 
by  a  short  mesoappendix.  The  appendix  is  about  9  cm. 
in  length,  .5  cm.  in  diameter,  and  with  a  lumen  about  .2  cm. 
in  diameter.  When  seen  from  the  front  the  first  7  cm.  of 
the  appendix  form  an  irregular  W-shaped  figure,  with  the 
last  2  cm.  lying  between  the  W  and  the  vertebral  column 
(Plates  XXVIII  and  XXXII).  The  caecum  is  almost  en- 
tirely covered  with  peritonaeum,  the  upper  part  being 
slightly  adherent  to  the  psoas  muscle  posteriorly  (Plate 
XXI).  It  lies  in  the  lateral  angle  of  the  body  cavity  be- 
tween the  iliopsoas  and  transversus  abdominus  muscles. 
Internal  to  it  are  coils  of  the  jejunoileum,  and  the  appendix. 

The  ascending  colon  is  considerably  distended  in  its 
lower  three-fourths,  and  fills  a  large  part  of  the  right  lumbar 
region  of  the  abdominal  cavity.  It  ascends  nearly  vertically 
upward  from  the  caecum  to  the  inferior  surface  of  the  liver. 
It  is  covered  with  peritonaeum  in  front  and  on  the  two  sides 
except  where  it  comes  into  contact  internally,  near  the 
hepatic  flexure,  with  the  duodenum  (Plate  XVIII).  The 
lower  half  is  in  relation  internally  with  the  jejunoileum, 
anteriorly  and  externally  with  the  body  wall.  Posteriorly 
it  is  attached  to  the  quadratus  and  psoas  muscles.  The 
upper  half  is  adherent  internally  to  the  second  portion  of 
the  duodenum  and  posteriorly  to  the  lower  half  of  the  kid- 
ney. Externally  it  is  in  contact  with  the  liver  and  anteriorly 
with  the  beginning  of  the  transverse  colon.  The  ureter  runs 
downward  internal  to  the  colon  but  does  not  enter  into 
close  relation  with  it  as  Plates  XXVIII  and  XXXII  might 
lead  one  to  believe. 

The  hepatic  flexure  is  at  the  level  of  the  second  lumbar 
vertebra  about  7  cm.  to  the  right  of  the  midplane  and  4  cm. 
in  front  of  the  midaxillary  plane.     Upon  the  anterior  wall 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN 


45 


it  may  be  located  a  little  internal  to  the  right  tenth  costal 
cartilage.  It  is  anterior  and  external  to  the  hilus  of  the 
kidney.  It  lies  between  the  right  lobe  of  the  liver  extern- 
ally and  the  descending  duodenum  internally.  The  right 
lobe  of  the  liver  lies  above  the  flexure  while  the  fundus  of 
the  gall  bladder  is  about  1  cm.  above  and  in  front  of  its 
highest  point. 

Quain*  locates  the  hepatic  flexure  at  the  level  of  the 
first  lumbar  while  Hermann  and  Ruedel^  locate  it  as  low 
as  the  upper  part  of  the  third  lumbar  vertebra. 

The  transverse  colon  is  also  distended  near  its  begin- 
ning but  the  part  lying  to  the  left  of  the  midline  is  con- 
tracted. At  the  hepatic  flexure  the  colon  turns  forward, 
downward  and  to  the  left.  The  downward  turn  is  small  so 
that  the  colon  soon  takes  a  direction  upward,  backward  and 
to  the  left  (Plates  XXVIII  and  XXXII)  to  reach  the  infer- 
ior pole  of  the  spleen.  The  highest  point  reached  by  the 
colon  is  at  the  level  of  the  upper  border  of  the  twelfth 
thoracic  vertebra  about  5  cm.  to  the  left  of  the  midplane  and 
about  5  cm.  in  front  of  the  midaxillary  plane.  From  this 
highest  point  the  colon  descends  rapidly,  crosses  the  mid- 
axillary  plane  at  the  level  of  the  first  lumbar  vertebra  and 
comes  into  contact  with  the  lower  end  of  the  spleen  (Plates 
XVI,  XXVIII,  XXIX,  XXXI,  XXXII,  XXXIII  and  XXXV). 
This  part  of  the  colon  is  peritonaeal  and  is  attached  to  the 
body  wall  by  a  mesocolon  which  arises  from  the  anterior 
surface  of  the  second  portion  of  the  duodenum  and  the 
head  and  anterior  border  of  the  pancreas.  It  is  bound 
more    or    less    closely    to    the    greater    curvature    of     the 

1  Thane,  G.  D.  and  Godlee,  R.  J.,     Quain's   elements   of  anatomy. 
Appendix.     Superficial  and  surgical  anatomy.     London,   1896. 

'Log.  cit. 


46  UNIVERSITY  OF  MISSOURI   STUDIES 

Stomach  by  the  great  omentum.  At  the  beginning  it  is  in 
relation  anteriorly  with  the  anterior  abdominal  wall,  ex- 
ternally and  superiorly  with  the  inferior  surface  of  the  right 
lobe  of  the  liver,  and  posteriorly  with  the  ascending  colon, 
second  portion  of  the  duodenum  and  the  head  of  the  pan- 
creas. A  little  higher  up  it  is  separated  from  the  duodenum 
by  the  antrum  pyloricum.  The  part  of  the  colon  lying  to 
the  left  of  the  midplane  is  in  relation  with  the  body  of 
the  pancreas  posteriorly,  from  the  upper  part  of  which  it  is 
separated  by  the  greater  curvature  of  the  stomach.  It 
arches  over  and  is  in  contact  with  the  duodenojejunal  angle. 
At  the  level  of  the  first  lumbar  vertebra  it  comes  into  con- 
tact with  the  inferior  portion  of  the  gastric  surface  of  the 
spleen,  and  becomes  retroperitonaeal. 

The  splenic  flexure  is  in  the  midaxillary  plane  at  the 
level  of  the  first  lumbar  vertebra.  It  is  separated  from 
the  ninth  intercostal  space  by  the  diaphragm  only,  and  from 
the  kidney  by  the  lower  part  of  the  tail  of  the  pancreas. 

The  descending  colon  is  more  contracted  than  the 
other  portions  of  the  large  intestine  and  extends  from  the 
splenic  flexure  to  the  crest  of  the  ilium.  It  lies  a  little 
posterior  to  the  midaxillary  plane,  and  runs  downward,  in- 
ward and  forward  between  the  kidney  and  the  lateral  body 
wall  above  and  the  psoas  and  quadratus  muscles  and  the 
body  wall  below.  It  is  covered  with  peritonaeum  on  its 
anterior  surface  and  a  part  of  each  lateral  surface.  Below 
the  spleen  and  pancreas  the  colon  lies  upon  the  external 
(anterior)  surface  of  the  kidney  (Plate  XVIII),  In  the 
lower  part  of  its  course  it  lies  in  the  groove  between  the 
psoas  and  quadratus  muscles.  Its  peritonaeal  surface  is  in 
contact  with  coils  of  the  jejunoileum. 

The  sigmoid  colon  lies  in  the  left  iliac  fossa  and  in  the 
true  pelvic  cavity.     It  continues  downward    in    the    same 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN         47 

direction  as  the  descending  colon  from  the  iliac  crest  to  the 
level  of  the  first  sacral  vertebra  where  it  turns  horizontally 
inward  and  backward  to  pass  over  the  brim  of  the  pelvis 
(Plates  XXVIII,  XXIX,  XXXII  and  XXXIII).  The  pelvic 
portion  of  the  sigmoid  is  coiled  upon  itself  and  lies  upon 
the  anterior  surface  of  the  rectum  in  the  region  of  the  first 
four  sacral  vertebrae.  The  iliac  portion  of  the  sigmoid  is 
contracted  but  soon  after  crossing  the  brim  of  the  pelvis 
the  colon  becomes  dilated.  It  turns  downward  for  a  short 
distance,  separated  from  the  anterior  wall  by  the  jejunoil- 
eum  and  its  mesentery.  Opposite  the  fourth  sacral  verte- 
bra the  colon  turns  upon  itself  in  the  anteroposterior  direc- 
tion and  passes  upward  between  the  descending  loop  and 
the  first  part  of  the  rectum.  At  the  level  of  the  second 
sacral  vertebra  the  intestine  makes  another  turn  in  the  an- 
teroposterior direction  and  joins  the  rectum.  Thus  there 
are  two  loops  of  the  sigmoid  and  the  first  part  of  the 
rectum  in  the  same  anteroposterior  plane  anterior  to  the 
middle  portion  of  the  sacrum.  The  iliac  portion  of  the 
sigmoid  rests  upon  the  iliopsoas.  Its  mesocolon  is  very 
short.  The  pelvic  portion  has  a  longer  mesocolon  which 
allows  it  to  swing  free  in  the  pelvic  cavity  where  it  is  in 
contact  anteriorly  and  laterally  with  the  jejunoileum. 

The  rectum,  the  remainder  of  the  large  intestine  may 
be  divided  into  two  parts  nearly  equal  in  length.  The 
upper  part  is  covered  upon  its  anterior  surface  with 
peritonaeum  and  extends  from  near  the  base  of  the  sacrum 
to  about  1  cm.  above  the  tip  of  the  coccyx.  The  lower 
part  lies  below  the  peritonaeal  cavity.  The  first  por- 
tion is  greatly  dilated  and  nearly  fills  the  true  pelvic 
cavity.  It  is  covered  with  peritonaeum  on  its  anterior  sur- 
face and  a  part  of  each  lateral  surface.  The  posterior  sur- 
face is  attached  to  the    concave    anterior    surface    of    the 


48  UNIVERSITY  OF  MISSOURI  STUDIES 

sacrum  and  coccyx  by  connective  tissue  containing  nerves, 
blood  vessels  and  lymph  glands.  On  either  side  of  the  rec- 
tum are  the  large  vessels  and  nerves  which  pass  out  through 
the  great  sacrosciatic  notch  (Plates  XXII  and  XXIII). 
Anteriorly  it  is  in  relation  above  with  the  pelvic  portion  of 
the  sigmoid  colon  and  below  with  the  bladder.  The  ureters 
and  vasa  deferentia  pass  across  the  lower  part  of  the  anterior 
surface  to  gain  the  posterior  surface  of  the  bladder  (Plate 
XXIII).  The  lower  half  of  the  rectum  is  contracted.  Its 
anterior  wall  is  a  vertical  continuation  of  the  anterior  wall 
of  the  upper  half.  It  is  surrounded  by  the  cone-shaped 
levator  ani  muscle  with  which  its  muscular  coat  becomes 
continuous  near  the  anus  (Plates  XXIV  and  XXV).  It  is 
in  contact  above,  anteriorly  with  the  prostate  gland  and 
posteriorly  wtih  the  tip  of  the  coccyx.  Its  lower  part  is 
separated  from  the  bulb  of  the  urethra  anteriorly  by  the 
perinaeal  body.  Its  relation  to  the  ischiorectal  fossae 
posterolaterally  is  well  shown  in  Plates  XXIV  and  XXV. 

THE  LIVER 

The  liver  is  seen  in  section  in  Plates  XII  to  XVIII 
and  in  projection  in  Plates  XXVIII  to  XXXV.  The  greater 
part  of  it  lies  in  the  right  hypochondriac  region,  but  it 
crosses  the  epigastric  into  the  left  hypochondriac  region. 
The  superior  boundary  of  the  surface  outline  is  nearly 
horizontal  and  crosses  the  sternum  at  the  level  of  the  fifth 
sternochondral  articulations  and  the  upper  border  of  the 
ninth  thoracic  vertebra.  In  the  midclavicular  regions  this 
boundary  is  in  the  fourth  intercostal  spaces  only  a  few  milli- 
meters higher  than  at  the  midline.  This  slight  difference 
is  due  to  the  fact  that  the  left  dome  of  the  diaphragm  is  at 
nearly  the  same  level  as  the  right  one.     The  right  boundary 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN         49 

of  the  surface  outline  is  slightly  convex  outward  following 
the  lateral  part  of  the  diaphragm  and  body  wall  down  to 
the  level  of  the  middle  of  the  third  lumbar  vertebra  about 
.5  cm.  below  the  lowest  point  of  the  tenth  rib.  The  inferior 
boundary  crosses  the  anterior  abdominal  wall  from  the  tip 
of  the  right  tenth  to  the  left  seventh  costal  cartilage  about 
1  cm.  above  the  tip  of  the  eighth  cartilage,  and  ends  behind 
the  left  sixth  rib  about  3  cm.  external  to  the  midclavicular 
line.  It  crosses  the  anterior  midline  about  7  cm.  below 
the  xiphosternal  articulation  or  about  one-third  of  the  dis- 
tance from  this  articulation  to  the  umbilicus.  The  inferior 
boundary  is  formed  by  the  anterior  border  and  when  seen 
from  behind  it  crosses  the  vertebral  column  from  the  right 
end  of  the  disc  between  the  twelfth  thoracic  and  first 
lumbar  vertebrae  to  the  left  end  of  the  next  disc  above. 
The  greatest  lateral  extent  of  the  liver  is  across  the  sixth 
sternochondral  articulations  and  tenth  vertebra,  where  the 
organ  extends  nearly  13  cm.  to  either  side  of  the  midline. 

When  seen  from  the  right  side  (Plates  XXX  and 
XXXIV)  the  liver  fills  the  upper  half  of  the  abdominal 
cavity.  Its  highest  point  is  about  5  cm.  and  its  lowest  1 
cm.  anterior  to  the  midaxillary  line.  It  is  about  18  cm. 
in  its  superoinferior  length. 

Plates  XXXI  and  XXXV  represent  the  left  lobe  of  the 
liver  only.  Since  this  lobe  is  very  thin  near  its  tip,  but 
enlarges  rapidly  near  the  midplane  of  the  body  a  double 
projection  is  given  in  order  to  show  the  relation  of  the 
liver  to  the  body  wall  and  to  the  other  organs  in  the  region. 
The  large  outline  is  from  measurements  at  the  junction 
of  the  right  and  left  lobes,  the  diagonal  crossing  this  out- 
line represents  the  course  of  the  anterior  border  of  the 
liver  from  the  tip  of  the  left  lobe  to  where  it  crosses  the 
midline  of  the  body. 
4 


5©  UNIVERSITY  OF  MISSOURI  STUDIES 

The  liver  is  separated  by  the  diaphragm  from  the  heart 
and  lung's.  The  superior  surface  of  the  right  lobe  is  al- 
most entirely  under  cover  of  the  base  of  the  right  lung. 
Near  the  midplane  it  is  overlaid  by  that  part  of  the  right 
auricle  into  which  the  vena  cava  inferior  opens.  The  super- 
ior surface  of  the  left  lobe  lies  under  the  heart  and  the  base 
of  the  left  lung.  The  anterointernal  part  of  the  surface  is 
in  relation  with  the  heart.  In  the  region  of  the  inferior 
caval  opening,  in  common  with  the  right  lobe,  the  left  lobe 
is  in  relation  with  the  right  auricle.  This  area  is  small 
and  lies  to  the  right  of  the  midplane  of  the  body.  The  re- 
mainder of  the  cardiac  area  is  roughly  quadrilateral  in 
form  and  is  divisible  into  an  anterointernal  and  a  postero- 
external triangle.  The  anterior  triangle  corresponds  to  the 
right  ventricle,  the  posterior  to  the  left  ventricle.  Posterior 
and  external  to  the  cardiac  area  the  liver  is  in  relation  with 
the  base  of  the  left  lung  (see  relations  of  lung  and  heart). 
Below  the  lungs  and  heart  the  superior  surface  of  the  liver 
is  in  contact  with  the  diaphragm  and  abdominal  wall. 

The  posterior  surface  of  the  right  lobe  is  attached  to 
the  diaphragm.  It  is  in  relation  through  the  diaphragm 
with  the  inner  and  posterior  part  of  the  base  of  the  right 
lung.  The  nonperitonaeal  upper  pole  of  the  suprarenal 
gland  is  interposed  between  this  surface  of  the  liver  and  the 
diaphragm  opposite  the  disc  between  the  eleventh  and 
twelfth  thoracic  vertebrae  (Plate  X\').  The  inner  part  of 
the  posterior  surface  is  separated  from  the  base  of  the 
Spigelian  lobe  by  a  deep  groove  containing  the  vena  cava 
inferior  (Plates  XIII,  XI\'  and  XV).  The  posterior  surface 
of  the  left  lobe  is  narrow  and  triangular  with  its  apex  out- 
ward towards  the  beginning  of  the  left  triangular  ligament. 
It  lies  in  section  XII  (not  shown  in  the  plates)   over  the 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN         5  I 

crura  of  the  diaphragrn  which  separates  it  from  the 
oesophagus  and  aorta. 

The  posterior  surface  of  the  Spigelian  lobe  corresponds 
to  the  tenth,  eleventh  and  upper  half  of  the  twelfth  thoracic 
vertebrae.  It  is  covered  with  peritonaeum  and  is  separated 
by  the  right  crus  of  the  diaphragm  from  the  base  of  the 
right  lung  and  oesophagus  above  (Plate  XIII)  and  from 
the  vena  azygos  major,  thoracic  duct  and  aorta  below 
(Plates  XIV  and  XV). 

The  inferior  surface  of  the  left  lobe  is  in  contact  with 
the  anterior  (superior)  surface  of  the  fundus,  body  and  a 
small  part  of  the  pyloric  portion  of  the  stomach.  The 
tuber  omentale  lies  upon  the  cardia  and  crura  of  the  dia- 
phragm above  and  the  lesser  curvature  and  lesser  omentum 
below  (Plates  XIII  and  XIV).  This  is  the  part  of  the  liver 
in  contact  with  the  oesophagus  from  where  the  oesophagus 
passes  through  the  diaphragm  to  where  it  enters  the 
stomach. 

That  portion  of  the  .Spigelian  lobe  belonging  to  the 
inferior  surface  is  separated  from  the  tuber  omentale  of  the 
left  lobe  of  the  liver  and  the  anterior  surface  of  the  stomach 
by  the  lesser  omentum.  The  left  or  free  margin  of  the 
Spigelian  lobe  is  in  close  relation  with  the  lesser  curvature 
of  the  stomach. 

The  right  portion  of  the  pars  pylorica  is  in  contact  with 
the  quadrate  lobe  and  the  gall  bladder.  In  front  of  the 
lower  part  of  the  pyloric  area  of  the  quadrate  lobe  is  a 
slight  depression,  continuous  with  a  similar  area  on  the 
right  lobe  in  which  the  transverse  colon  is  seen  in  Plates 
XVII  and  XVIII. 

Anterior  to  the  midaxillary  plane  the  inferior  surface  of 
the  right  lobe  is  in  relation  with  the  root  structures  of  the 
liver  and  the  vena  cava  inferior  in  the    upper    part,    the 


52 


UNIVERSITY  OF  MISSOURI  STUDIES 


duodenum  in  the  middle  part  and  the  hepatic  flexure,  as- 
cending, and  transverse  colons  in  the  lower  part  (Plates 
XVII  and  XVIII).  Posterior  to  the  midaxillary  plane  the 
right  lobe  is  fitted  over  the  upper  half  of  the  anterior  sur- 
face of  the  right  kidney  (Plates  XVI,  XVII  and  XVIII). 
The  peritonaeal  portion  of  the  right  suprarenal  gland  comes 
into  contact  with  this  surface  of  the  liver  between  the 
upper  part  of  the  kidney  and  vena  cava  inferior  (Plate 
XVI).  This  area  is  continuous  with  the  suprarenal  area 
on  the  posterior  surface  seen  in  Plate  XV.  The  liver  does 
not  come  into  contact  with  the  jejunoileum  at  any  point. 

The  gall  bladder  lies  along  the  right  costal  margin  with 
its  right  half  under  cover  of  the  eighth  and  ninth  costal  car- 
tilages. It  is  only  moderately  distended  so  that  it  is  entirely 
under  cover  of  the  liver  anteriorly.  It  lies  in  a  shallow 
groove  between  the  right  and  quadrate  lobes  and  is  in  con- 
tact internally  with  the  pylorus  and  first  part  of  the  duo- 
denum (Plates  XVI  and  XVII).  The  fundus  is  about  1 
cm.  above  and  in  front  of  the  highest  part  of  the  hepatic 
flexure.  The  neck  is  prolonged  upward  and  inward  as  the 
cystic  duct  into  the  hepatoduodenal  ligament.  This  liga- 
ment connects  the  liver,  above  the  neck  of  the  gall  bladder, 
with  the  superior  duodenum,  pancreas,  and  pylorus  and  con- 
tains the  bile  duct,  hepatic  artery,  portal  vein  and  lymph 
glands,  in  their  usual  relations  to  each  other.  The  root 
structures  of  the  liver  are  separated  from  the  vena  cava  in- 
ferior by  a  small  peritonaeal  pocket,  the  beginning  of  the 
vestibule  of  the  lesser  peritonaeal  cavity  (Foramen  epiploi- 
cum   [Winslowi],  Plate  XVI). 

The  main  differences  in  position  and  relations  of  the 
liver  as  seen  in  these  plates  and  that  usually  described  seems 
to  be  due  to  two  conditions :  First,  the  left  lobe  is  com- 
pressed in  the  superoinferior  direction  and  extends  far  over 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN        53 

into  the  left  hypochondriac  region ;  second,  the  left  dome  of 
the  diaphragm  is  about  as  high  as  the  right,  permitting  the 
left  lobe  of  the  liver  to  rise  to  the  same  level  as  the  right 
lobe.  The  tip  of  the  left  lobe  is  from  2  to  5  cm.  farther  to 
the  left  of  the  midline  than  is  figured  in  Toldt,  Joessel,  Her- 
mann und  Ruedel,  Cunningham,  and  Quain.  Deaver  says 
that  the  left  lobe  rarely  extends  more  than  5  cm.  to  the 
left  of  the  sternum.  The  superior  surface  is  more  horizon- 
tal than  shown  in  I\Ierkel,  Quain,  Joessel,  et  al.  The  dif- 
ference is  due  largely  to  the  higher  level  of  the  upper 
border  of  the  left  lobe  in  this  case.  Joessel  places  the  high- 
est point  of  the  left  lobe  nearly  2  cm.  lower  and  much  nearer 
the  midplane  than  in  this  subject.  The  level  of  the  upper 
border  of  the  right  lobe  corresponds  more  closely  to  the 
locations  given  by  the  above  anatomists  than  does  that  of 
the  left  lobe.  Deaver  places  it  at  the  lower  border  of  the  fifth 
rib  in  the  mammary  line,  while  Hermann  and  Ruedel  place 
it  at  the  upper  margin  of  the  fourth  rib.  However  it  is 
probable  that  this  seemingly  great  difference  is  due  to  the 
differences  in  the  relation  of  the  sternum  and  ribs  to  the 
vertebral  column  in  the  two  subjects.  This  is  true  with  re- 
spect to  the  difference  between  Hermann  and  Ruedel's  pro- 
jections and  those  in  this  paper,  since  in  both  the  upper 
boundary  corresponds  to  the  upper  margin  of  the  ninth 
thoracic  vertebra.  The  only  other  difference  to  be  noted 
is  the  obliquity  of  the  anterior  border.  This  is  due  to  the 
left  lobe  being  somewhat  higher  than  usual  and  very  thin 
in  its  superoinferior  direction .  This  border  as  given  by 
most  anatomists  crosses  the  anterior  abdominal  wall  from 
the  ninth  right  to  the  eighth  left  costal  cartilage,  or  much 
more  nearly  horizontal  than  this  one. 


54  UNIVERSITY  OF  MISSOURI  STUDIES 

THE  PANCREAS 

The  pancreas  is  seen  in  Plates  XVI,  XVII,  XVIII, 
XXVIII  and  XXXII.  The  head  lies  anterior  to  the  first 
two  lumbar  vertebrae.  It  fills  the  concavity  of  the  duo- 
denum, with  its  lower  part  lying  upon  the  anterior  surface 
of  the  transverse  duodenum.  The  body  of  the  gland  ex- 
tends outward  from  the  upper  and  left  part  of  the  head  to 
the  lower  part  of  the  gastric  surface  of  the  spleen.  It 
passes  above  and  behind  the  duodenojejunal  angle,  between 
it  and  the  hilus  of  the  left  kidney.  The  tail  is  the  triangu- 
lar pyramidal  extremity  of  the  gland,  which  turns  upward 
from  the  outer  end  of  the  body  into  the  space  between  the 
spleen,  kidney  and  stomach. 

The  head  is  flat  with  its  posterior  surface  bound  tightly 
to  the  vena  cava  inferior  and  left  renal  vein  above  and  the 
transverse  duodenum  below.  The  vena  cava  and  renal  vein 
separate  it  from  the  crura  of  the  diaphragm.  The  anterior 
surface  of  the  head  is  covered  with  peritonaeum  and  is  in 
relation  with  the  pylorus  and  the  transverse  colon.  The 
right  border  of  the  head  is  attached  to  the  left  side  of  the 
descending  duodenum  and  presents  a  groove  in  its  upper 
half  in  which  the  common  bile  duct  passes  downward  to 
open  into  the  posterior  part  of  the  descending  duodenum. 
The  left  border  of  the  head  is  separated  from  the  ascending 
duodenum  by  the  superior  mesenteric  vessels.  These  vessels 
make  a  groove  in  the  pancreas,  which  begins  above  near 
the  posterior  part  of  the  left  side  and  runs  downward  and 
forward  across  the  left  border  to  reach  the  base  of  the 
mesentery  (Plates  XVII  and  XVIII). 

The  body  of  the  pancreas  is  prismatic  in  form.  The 
anterior  surface  is  peritonaeal,  faces  upward  and  forward 
and  is  in  relation  with  the  posterior  surface  of  the  stomach. 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN         55 

The  inferior  surface  is  also  peritonaeal.  It  faces  downward 
and  a  little  forward  and  is  in  relation  by  its  inner  part  with 
the  duodenojejunal  angle  and  by  its  outer  part  with  coils 
of  the  jejunoileum.  The  anterior  border  which  separates 
these  two  surfaces  is  very  well  marked  in  its  outer  two- 
thirds  where  it  gives  attachment  to  the  transverse  meso- 
colon. 

The  posterior  surface  is  retroperitonaeal.  It  is  in  con- 
tact, near  the  midline  of  the  body,  with  the  coeliac  axis  and 
mesenteric  vessels.  The  splenic  vessels  run  across  the 
posterior  surface,  in  a  shallow  groove,  from  within  outward 
and  upward.  The  coeliac  plexus  and  the  semilunar  ganglia 
surrounding  these  vessels  separate  the  pancreas  from  the 
crura  of  the  diaphragm  in  the  region  of  the  twelfth  thor- 
acic and  first  lumbar  vertebrae  (Plate  XVI).  The  outer  half 
of  this  surface  rests  upon  the  left  suprarenal  gland  and  kid- 
ney. The  pancreas  is  in  contact  with  the  lower  two-thirds 
of  the  suprarenal.  Just  external  to  the  suprarenal  the  pan- 
creas is  bound  to  the  kidney  from  about  2  cm.  below  the 
upper  pole  to  the  middle  of  the  hilus.  The  outermost  part 
of  the  posterior  surface  is  in  contact  with  the  spleen.  The 
part  of  the  spleen  in  contact  with  the  body  of  the  pancreas 
is  small  and  lies  between  the  gastric  and  renal  surfaces  of 
the  spleen,  and  below  the  splenic  area  in  contact  with 
the  tail  of  the  pancreas. 

The  tail  of  the  pancreas  is  peritonaeal  on  its  anterior 
surface  only  where  it  is  in  relation  with  the  posterior  sur- 
face of  the  stomach.  Its  inferior  (external)  surface  is 
attached  to  the  spleen,  its  posterior  (internal)  surface  to 
the  anteroexternal  surface  of  the  kidney.  The  splenic  vessels 
run  along  its  superior  border  and  pass  over  its  apex  to  reach 
the  hilus  of  the  spleen.     The  lowest  portion  of  the  tail,  at 


56  UNIVERSITY  OF  MISSOURI  STUDIES 

its  junction  with  the  body,  is  in  close  relation  anteroextern- 
ally  with  the  splenic  flexure  of  the  colon  (Plates  XVI, 
XVII,  XXVIII  and  XXXII). 

THE  SPLEEN 

The  spleen  appears  in  Plates  XIII  to  XVI  and  XXVIII, 
XXIX,  XXXI,  XXXII,  XXXIII  and  XXXV.  It  lies  in  the 
left  hypochondriac  region  upon  the  diaphragm  and  posterior 
abdominal  wall  opposite  the  ninth,  tenth  and  eleventh  ribs. 
The  upper  pole  is  at  the  level  of  the  lower  border  of  the 
ninth  thoracic  vertebra,  and  the  lower  pole  at  the  level  of 
the  lower  border  of  the  first  lumbar  vertebra.  Upon  the 
anterior  body  wall  the  upper  pole  is  at  the  level  of  the 
lower  border  of  the  fifth  rib  in  the  midclavicular  line,  8 
cm,  from  the  midline,  and  the  lower  pole  in  the  eighth  inter- 
costal space,  about  11  cm.  from  the  midline.  The  organ  is 
ovoid  in  outline.  Its  long  axis  is  11  cm.  in  length  and  a 
little  more  nearly  vertical  than  the  tenth  rib,  inclining  from 
above  downward,  outward  and  forward. 

The  external  or  diaphragmatic  surface  is  directed  back- 
ward in  the  upper  half  and  outward  in  the  lower  half,  and 
is  in  contact  with  the  diaphragm  (Plates  XIV,  XV  and 
XVI).  The  upper  part  of  this  surface  is  in  relation  with 
the  posterior  part  of  the  base  of  the  left  lung  (Plate  XIII). 

The  upper  pole  is  separated  from  the  posterior  and  ex- 
ternal part  of  the  inferior  surface  of  the  left  lobe  of  the  liver 
by  a  portion  of  the  fundus  of  the  stomach.  The  upper  pole 
and  the  greater  part  of  the  external  and  gastric  surfaces 
are  covered  with  peritonaeum.  The  posterior  (internal) 
border  is  bound  to  the  diaphragm.  The  anterior  (external) 
border  is  free  in  its  upper  three-fourths,  and  adherent  to  the 
splenic  flexure  in  its  lower  fourth. 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN         57 

The  internal  surface  may  be  divided  into  four  areas  cor- 
responding to  the  four  organs  in  contact  with  the  spleen 
anterointernally.  The  gastric  area  includes  a  little  more 
than  the  upper  half  of  the  spleen  and  may  be  bounded  be- 
low by  a  line  drawn  from  the  middle  of  the  posterior  border 
to  the  junction  of  the  upper  three-fourths  with  the  lower 
fourth  of  the  anterior  border.  The  upper  and  inner  part  of 
this  area  of  the  spleen  is  adherent  to  the  stomach  (Plate 
XIV),  The  remainder  of  the  gastric  area  is  separated  from 
the  stomach  by  the  lesser  peritonaeal  cavity  internal  to  the 
hilus  of  the  spleen  and  by  the  gastrosplenic  omentum  and 
greater  peritonaeal  cavity  external  to  the  hilus.  The  pos- 
terior part  of  the  internal  surface  below  the  gastric  area  is 
in  contact  with  the  posterior  part  of  the  anterior  (external) 
surface  and  external  border  of  the  kidney.  The  pancreatic 
area  is  a  small  triangular  space  between  the  lower  part  of 
the  gastric  area  anterosuperiorly,  the  renal  area  posteriorly 
and  the  posterior  border  of  the  spleen  near  the  inferior 
pole,  inferiorly.  The  remainder  of  the  internal  surface  of 
the  spleen,  including  the  inferior  pole,  is  in  contact  with 
the  splenic  flexure  of  the  colon. 

Ouain  places  the  upper  pole  of  the  spleen  at  the  level 
of  the  disc  between  the  tenth  and  eleventh  vertebrae,  and 
the  lower  pole  at  the  first  lumbar  vertebra.  Deaver  places 
the  upper  limit  at  the  ninth  and  the  lower  limit  at  the 
eleventh  thoracic  spine.  Both  of  these  measurements  give 
a  very  much  shorter  spleen  than  is  seen  in  this  subject. 

THE  KIDNEYS 

The  kidneys  appear  in  Plates  XVI,  XVII,  XVIII,  and 
XXVIII  to  XXXV.  The  two  organs  present  many  points 
in  common  but  differ  sufficiently  in  the  details    of    their 


58  UNIVERSITY  OF  MISSOURI  STUDIES 

topography  to  require  a  separate  discussion   of  each. 

The  right  kidney  is  of  a  long  oval  shape  with  its  two 
margins  of  nearly  the  same  curvature.  It  lies  upon  the 
posterior  body  wall  in  the  right  lumbar  region,  and  ex- 
tends from  the  level  of  the  middle  of  the  twelfth  thoracic 
to  the  middle  of  the  third  lumbar  vertebra.  Its  long 
axis  extends  from  below  upward,  backward  and  inward, 
and  if  prolonged  upwards  it  would  cross  the  midplane 
behind  the  middle  of  the  tenth  thoracic  vertebra.  The 
upper  pole  is  about  3.5  cm.  from  the  midplane  and  2.5  cm. 
behind  the  midaxillary  plane  while  the  lower  pole  is  about 
9  cm.  from  the  midline  in  the  midaxillary  plane.  Thesupero- 
external  half  of  the  posterior  surface  lies  over  the  eleventh 
intercostal  space,  and  twelfth  rib  (Plates  XXIX  and 
XXXIII).  The  lower  half  of  the  organ  lies  below  and  in- 
ternal to  the  twelfth  rib.  The  kidney  is  separated  from 
the  vertebral  column  above  the  second  lumbar  vertebra  by 
the  diaphragm,  and  below  this  level  by  the  psoas  major. 

The  anterior  surface  of  the  right  kidney  is  peritonaea! 
for  the  most  part,  and  in  relation  with  the  posterior  part  of 
the  inferior  surface  of  the  liver.  When  seen  from  the  front 
the  kidney  is  nearly  covered  by  the  eighth,  ninth  and  tenth 
right  costal  cartilages  (Plates  XXVIII  and  XXXII).  The 
lower  half  of  the  suprarenal  fits  over  the  upper  part  of  the 
medial  border  and  separates  the  kidney  from  the  vena  cava 
inferior  (Plate  XVI).  The  duodenum  is  bound  to  the 
medial  border  and  anterior  surface  from  the  suprarenal  down 
to  the  lower  part  of  the  hilus.  From  the  hilus  to  the  lower 
pole,  external  to  the  duodenum,  the  hepatic  flexure  and  as- 
cending colon  cover  the  internal  part  of  the  anterior  sur- 
face of  the  kidney.  The  hilus  is  opposite  the  second  lum- 
bar vertebra. 

The  left  kidney  is  shorter,  broader   and    thicker    than 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN 


59 


the  right.  Its  outer  border  is  much  more  convex  than  its 
inner.  The  organ  is  located  on  the  posterior  abdominal 
wall  in  the  left  lumbar  region  extending  from  the  disc  be- 
tween the  eleventh  and  twelfth  thoracic  vertebrae  to  the 
disc  between  the  second  and  third  lumbar  vertebrae.  It 
is  less  inclined  than  the  right  kidney,  in  both  the  frontal 
and  the  sagittal  plane.  If  its  long  axis  were  prolonged  up- 
ward it  would  cross  the  midplane  in  the  region  of  the  sixth 
thoracic  vertebra.  The  upper  pole  is  about  4  cm.  from  the 
midplane  while  the  lower  pole  is  only  about  7  cm.  from  it. 
The  entire  organ  lies  behind  the  midaxillary  plane  (Plates 
XXXI  and  XXXV),  and  at  a  slightly  higher  level  than  the 
right  kidney  (Plates  XVI,  XVII,  XVIII  and  XXVIII  to 
XXXV).  Posteriorly  it  hes  over  the  eleventh  rib,  eleventh 
intercostal  space  and  the  twelfth  rib.  It  does  not  extend 
below  the  tip  of  the  twelfth  rib  more  than  about  1  cm., 
while  the  right  kidney  extends  nearly  4  cm,  below  the  tip 
of  the  right  twelfth  rib.  When  seen  from  the  front  more 
than  one-half  of  the  left  kidney  is  under  cover  of  the  costal 
arch  extending  as  far  outward  as  the  seventh  costochon- 
dral  articulation.  The  posterior  surface  rests  upon  the  dia- 
phragm above  and  the  psoas  and  quadratus  muscles  below. 
The  body  of  the  pancreas  crosses  the  anterior  surface 
of  the  kidney  in  the  region  of  the  hilus  dividing  it  into 
three  areas.  Above  the  pancreas  the  kidney  is  in  relation 
with  the  suprarenal,  stomach  and  spleen,  and  below  the 
pancreas,  with  the  colon  and  jejunoileum.  The  suprarenal 
fits  over  the  upper  pole  and  medial  border  down  to  the 
hilus.  The  lower  part  of  the  suprarenal  separates  a  por- 
tion of  the  kidney  from  the  pancreas  (Plate  XVI).  The 
posterior  part  of  this  upper  area  and  the  lateral  border  are 
attached  to  the  spleen.  The  remainder  of  this  upper  area 
is  in  relation  with  the  stomach.     It  is  small  and  bounded 


6o  UNIVERSITY  OF  MISSOURI   STUDIES 

below  by  pancreas,  in  front  by  suprarenal,  above  by  the 
upper  pole  of  the  kidney  from  the  suprarenal  to  the  splenic 
area,  and  externally  by  the  spleen  above  and  the  tail  of  the 
pancreas  below,  (Plates  XVI,  XXVIII  and  XXXII).  This 
gastric  area  is  the  only  peritonaeal  area  of  the  left  kidney 
above  the  lower  border  of  the  pancreas.  Below  the  pan- 
creas the  external  part  of  the  anterior  surface  is  bound  to 
the  descending  colon.  The  internal  part  of  this  surface  is 
covered  with  peritonaeum  and  is  in  relation  with  coils  of 
the  jejunoileum. 

The  hilus  of  the  left  kidney  is  also  a  little  higher  than 
that  of  the  right.  It  is  opposite  the  lower  half  of  the  first 
lumbar  and  the  first  lumbar  intervertebral  disc. 

The  upper  poles  of  the  kidneys  are  here  from  a  half 
to  an  entire  vertebra  lower  than  the  positions  given  by 
Thane  and  Godlee,  Merkel  and  Deaver.  The  lower  poles 
correspond  more  closely  to  their  descriptions. 

THE  URETERS  AND  THE  BLADDER 

The  ureters  He  upon  the  psoas  major  muscles  in  the 
abdominal  cavity  and  the  obturator  internus  muscles  in 
the  pelvic  cavity.  At  first  each  ureter  is  external  to  the 
psoas  minor  and  its  tendon,  but  crosses  the  tendon  at  the 
fourth  lumbar  vertebra.  Near  the  brim  of  the  pelvis  each 
ureter  comes  into  close  relation  with  the  anterior  surface  of 
the  common  iliac  vein  (Plate  XXI).  The  ureters  pass  down 
the  lateral  pelvic  walls  in  company  with  the  internal  iliac 
veins  and  their  superior  vesical  branches  (Plates  XXII  and 
XXIII).  At  the  hilus  of  the  kidney  each  ureter  lies  behind 
the  renal  vessels.  From  the  renal  vessels  down  to  the  brim 
of  the  pelvis  the  ureters  lie  behind  the  peritonaeum  of  the 
posterior  abdominal  wall  and  are  in  relation  with  coils  of 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN         6l 

the  jejunoileum.  In  the  pelvic  cavity  they  lie,  at  first,  by 
the  side  of  the  rectum,  but  lower  down  pass  across  its  an- 
terior surface  to  reach  the  posterior  surface  of  the  bladder. 
In  going  from  kidney  to  bladder  each  ureter  inclines  in- 
ward and  forward  (Plates  XXVIII  to  XXXV). 

The  bladder  was  empty  in  this  subject.  It  lies  entirely 
within  section  XXIII,  between  the  heads  of  the  recti  mus- 
cles and  the  upper  half  of  pubic  arch  anteriorly  and  the 
rectum  in  the  region  of  the  coccyx  posteriorly. 

THE  SUPRARENAL  GLANDS 

The  right  suprarenal  gland  extends  from  the  lower 
part  of  the  eleventh  thoracic  vertebra  to  the  lower  part  of 
the  first  lumbar  vertebra.  It  lies  along  the  upper  half  of 
the  medial  border  of  the  right  kidney  and  extends  above 
the  kidney  into  the  space  between  the  posterior  surface  of 
the  liver  and  the  diaphragm  (Plate  XV).  It  is  in  contact 
posterointernally  with  the  diaphragm  and  anterointernally 
with  the  vena  cava  inferior.  The  upper  half  is  nonperiton- 
aeal,  the  lower  half  is  covered  with  peritonaeum  on  its  an- 
terior surface  and  is  in  contact  with  the  inferior  surface  of 
the  liver.  The  inferior  pole  lies  posterior  to  the  first  part  of 
the  duodenum  (Plate  XVII). 

The  left  suprarenal  is  shorter  and  broader  than  the 
right  one.  The  upper  pole  is  about  .7  cm.  lower  than  that 
of  the  right.  It  covers  the  medial  border  of  the  left  kidney 
from  the  upper  pole  to  the  hilus.  Its  posterior  (internal) 
surface  lies  upon  the  diaphragm.  Its  anterior  (external) 
surface  is  covered  with  peritonaeum  above  the  superior  bor- 
der of  the  pancreas,  where  it  is  in  contact  with  the  posterior 
surface  of  the  stomach.  The  remainder  of  the  anterior  sur- 
face is  in  contact  with  the  posterior  surface  of  the  pancreas. 
The  lower  pole  lies  just  above  the  left  renal  vessels. 


62  UNIVERSITY  OF    MISSOURI  STUDIES 

These  suprarenal  glands  differ  in  their  topography 
from  what  is  given  by  topographic  anatomists  in  about  the 
same  way  as  do  the  kidneys  since  the  two  organs  are  so 
intimately  connected.  They  do  not  have  the  characteristic 
Y-shape  in  the  projections  because  only  the  widest  part  of 
the  outline  was  measured  in  each  plane. 

THE  THYREOID  GLAND 

The  thyreoid  gland,  while  not  belonging  to  the  thoracic 
and  abdominal  viscera,  was  included  in  the  projections  in 
order  to  show  its  relation  to  the  lungs,  trachea,  oesopha- 
gus, heart  and  great  vessels. 

The  left  lateral  lobe  of  the  thyreoid  is  the  larger  and 
extends  from  the  middle  of  the  ala  of  the  thyreoid  carti- 
lage to  the  fifth  ring  of  the  trachea,  or  from  the  lower  bor- 
der of  the  fifth  cervical  to  the  middle  of  the  second  thoracic 
vertebra.  It  is  in  relation  internally  with  the  larynx  and 
pharynx  above,  and  with  the  trachea  below;  posterointer- 
nally  with  the  longus  colli  above  and  the  oesophagus  be- 
low; posteroexternally  with  the  common  carotid  artery  and 
internal  jugular  vein ;  and  anteroexternally  with  the  sterno- 
thyreoid  muscle,  and  near  the  apex  with  the  omohyoid 
muscle. 

The  right  lateral  lobe  is  shorter  and  broader  than  the 
left.  Its  relation  is  about  the  same  as  that  of  the  left 
lobe  except  that  being  the  broader  it  projects  backward 
over  the  side  of  the  oesophagus  more  than  the  left  one 
(Plate  III). 

The  superior  thyreoid  vessels  and  recurrent  laryngeal 
nerves  are  to  be  seen  in  Plates  III  and  IV,  between  the  sur- 
face of  each  lobe  and  the  oesophagus.  The  lower  part  of 
each  lobe  is  separated  from  the  apex  of  the  corresponding 
lung  by  the  vessels  and  nerves  of  the  region. 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN        63 

The  lateral  lobes  are  connected  to  each  other  in  their 
lower  halves  by  the  isthmus,  which  lies  upon  the  anterior 
surface  of  the  trachea  over  the  second,  third  and  fourth 
tracheal  rings.  It  is  difficult  to  distinguish  the  lines  of 
separation  between  the  lateral  lobes  and  the  isthmus 
(Plate  IV).  From  the  upper  border  of  the  isthmus  a  small 
pyramidal  lobe  rises.  It  lies  over  the  first  tracheal  ring 
and  the  arch  of  the  cricoid  cartilage. 

TABLE  OF  LEVELS 

In  the  following  table  of  levels,  the  thoracic  vertebrae 
are  denoted  by  the  letter  T,  with  a  subscript  to  indicate 
the  particular  vertebra  in  question.  The  lumbar  vertebrae 
are  denoted  by  the  letter  L  in  the  same  way.  The  interver- 
tebral discs  are  denoted  by  the  letter  D  with  the  subscripts 
1  to  12,  for  those  in  the  thoracic  region,  and  1  to  5  for  those 
in  the  lumbar  region.  The  number  of  the  disc  corresponds 
to  the  number  of  the  vertebra  immediately  above.  The  tips 
of  the  spinous  processes  are  denoted  by  the  letter  S.  The 
same  subscripts  are  used  as  in  the  case  of  the  centra.  R  and 
C  are  the  abbreviations  used  for  rib,  and  costal  cartilage. 
On  account  of  the  fact  that  the  vertebral  column  is  the 
axis  of  the  skeleton,  and  especially  on  account  of  its  being 
divided  into  alternate  centra  and  discs  which  are  convenient 
as  points  of  reference  it  has  been  taken  as  the  basis  of  this 
table.  Only  those  points  which  are  fixed  and  at  the  same 
time  readily  accessible,  have  been  used  in  establishing  levels 
upon  the  anterior  body  wall.  The  tips  of  the  spinous  pro- 
cesses have  been  used  not  because  they  are  fixed  and  con- 
stant but  because  they  are  the  only  accessible  points  upon 
the  posterior  body  wall. 

The  table  is  based  upon  imaginary  horizontal  sections 


64  UNIVERSITY  OF  MISSOURI  STUDIES 

through  the  middle  of  each  thoracic  or  lumbar  vertebra  or 
intervertebral  disc.  Each  part  is  given  at  the  level  which 
comes  nearest  to  it.  Thus  the  upper  border  of  an  organ 
may  be  at  the  level  of  the  upper  border  of  a  centrum,  but 
w^ill  appear  in  the  table  as  if  cut  by  the  section  through  the 
disc  above,  because  that  level  shows  more  accurately  the 
position  of  the  part  than  the  level  through  the  middle  of 
the  centrum. 

The  first  column  of  the  table  shows  the  level  of  the 
section,  upon  the  vertebral  column,  which  would  pass 
through  the  parts  named  in  the  second  column.  The  third 
column  is  a  condensation  of  Quain's^  table  of  levels  and  is 
included  in  this  table  to  show  what  each  plane  would  pass 
through  were  all  the  parts  in  their  average  position. 

The  skeletal  parts  are  named  first  in  each  column,  be- 
ginning each  time  at  the  anterior  midline  and  going  around 
the  lateral  body  wall  to  the  vertebral  column. 


1  Thane,  G.  D.   and  Goalee,  R.  J.,    Quain's  elements  of  anatomy. 
Appendix.     Superficial  and  surgical  anatomy.     London,  1896. 


TABLE  OF  STRUCTURES  FOUND 
AT  VARIOUS  LEVELS 


J3  T3    O 


Ti 


In  This  Subject 


In  Quain's  Table 


RiSj.  Apices  of  lungs.  Sum- 
mits of  arches  of  subclavian 
arteries. 

Isthmus  of  thyreoid  gland. 
Arch  of  thoracic  duct. 


Ri.     Apices  of  lungs. 


Summits     of    arches    of    sub- 
clavian arteries. 


Dx 


Rj.j-  Sj.  Lower  limit  of  thy- 
reoid gland.  Formation  of 
innominate  veins.  Bifurca- 
tion of  innominate  artery. 


Inner  end  of  clavicle.  Ri.2- 
Bifurcation  of  innominate  ar- 
tery. 


D, 


Upper  border  of  sternal  end 
of  clavicle. 


Upper  edge  of  manubrium. 


D, 


Upper   border    of    sternum. 
Sternoclavicular  articula- 

tions. Ri_3.  S3.  Formation 
of  vena  cava  superior.  Origin 
of  innominate,  left  subclav- 
ian and  left  common  carotid 
arteries. 


Cj.R^.3.  Innominate  artery 
and  veins.  Formation  of  vena 
cava  superior. 


Upper  border  of  first  costal 
cartilages.  Great  fissure  of 
left  lung  posteriorly.  High- 
est point  of  pericardium. 


Highest  part  of  arch  of  aorta. 


First  sternochondral  articu- 
lations. R2.4.  Arch  of  aorta. 
Great  fissure  of  right  lung 
posteriorly.  Arch  of  azygos 
vein. 


Arch  of  aorta. 


D. 


Sternum  across  first  inter- 
costal spaces.  Bifurcation 
of  trachea.  Upper  limit  of 
roots  of  lungs. 

6^ 


Bifurcation  of  trachea, 
of  azygos  vein. 


Arch 


66 


UNIVERSITY  OF  MISSOURI  STUDIES 


Second  sternochondral  artic- 
ulations. R3.5.  S4.  Bronchi. 
Bifurcation  of  pulmonary 
artery.  Pulmonary  orifice. 
Highest  part  of  right  auricle. 


Junction  of  manubrium  with 
body  of  sternum.  Second  sterno- 
chondral articulations.  C  j. 
R2.5.  Bronchi.  Left  pulmon- 
ary artery.  Highest  part  of 
roots  of  lungs. 


D, 


Sternum  across  second 
intercostal  spaces.  S5.  Bi- 
furcation of  fissure  of  right 
lung.  Highest  part  of  left 
auricle.  End  of  vena  cava  su- 
perior. 


Highesf  part  of  heart. 


D, 


Upper  border  of  third  costal 
cartilages.  Rj.e-  Aortic  ori- 
fice. Upper  part  of  mitral 
orifice. 


R3.5.  Ascending  aorta.  Pul- 
monary orifice.  Pulmonary  ar- 
tery. Left  bronchus.  End  of 
vena  cava  superior. 


Third  sternochondral  artic- 
ulations. Highest  part  of 
tricuspid  valve.  Lower  part 
of  root  of  left  lung. 


Third  sternochondral  articula- 
tions. 


D, 


D, 


Sternum  across  third  inter- 
costal spaces.  R4-7-  Sg. 
Great  fissure  of  left  lung  at 
midaxillary  line. 


R4.7.  Aortic  orifice.  Infun- 
dibulum  of  right  ventricle. 
Lowest  part  of  roots  of   lungs. 


Fourth  sternochondral  artic- 
ulations. Lower  limit  of 
mitral  orifice.  Lowest  part 
of  left  auricle.  Coronary 
sinus.  Lowest  point  of  su- 
perior lobe  of  right  lung. 
Lower  limit  of  root  of  right 
lung. 


Sternum  at  lower  border  of 
fourth  costal  cartilage.  Rs-g. 
S7.     Left  nipple. 


Fifth  sternochondral  articu- 
lations. Lower  limit  of  tri- 
cuspid orifice.  Apex  of  left 
ventricular  cavity.  Right  and 


Fourth  sternochondral  articu- 
tions.  Nipple.  C4.  Ri.s- 
Both  auriculo-ventricular  ori- 
fices. 


Right  vault  of  diaphragm. 
Orifice  of  vena  cava  inferior. 
Right  auriculo-ventricular  ori- 
fice. 


TOPOGRAPHY  OF  THE  THORAX  AND  ABDOMEN 


67 


Dc 


Ti, 


Dio 


Ti: 


Dii 


Ti; 


Di 


left  domes  of  diaphragm. 
Highest  points  of  right  and 
left  lobes  of  the  liver.  Right 
nipple. 


Sixth  and  seventh  sterno- 
chondral  articulations. 
Xiphosternal  articulation. 
C7.5.  Rg-g.  Sg.  Highest 
point  of  fundus  of  stomach. 
Lower  border  of  heart  in 
midline.  Inferior  vena  caval 
opening  through  diaphragm. 


Base  of  xiphoid  process. 
Apex  of  heart.  Inferior  mar- 
gin of  right  lung  and  of  left 
lung  anteriorly.  Upper  pole 
of  spleen.  Oesophageal 
opening  through  diaphragm. 


Middle  of  xiphoid  process. 
C7.8.  Rfi-io-  Sg.  Cardiac 
orifice  of  stomach. 


Lower    limit    of    left    lung 
posteriorly. 


Fifth  and  sixth  sternochondral 
articulations.  Cr,.         R  g-g. 

Liver.   Left  vault  of  diaphragm 
and  fundus  of  stomach. 


Xiphosternal  articulation. 

Seventh  sternochondral  articu- 
lations.     Lowest  part  of  heart. 


Xiphoid        process.  C7  j. 

Rj-iQ.       Cardiac       orifice      of 
stomach. 


Upper  pole  of  spleen. 


Apex  of  xiphoid  process. 
C7.  R7.11.  SiQ.  Upper  limit 
of  hilus  of  spleen. 


Junctions  of  seventh  and 
eighth  costal  cartilages.  Sjj^. 
Upper  pole  of  left  kidney. 
Apices  of  suprarenal  glands. 


Cg-T.Rg-ja- S12.  Upper  pole 
of  right  kidney.  Upper  bor- 
der of  body  and  tail  of  pan- 
creas.    Neck  of  gall  bladder. 


C7.  R7-H.       Lower    mar- 

gin of  lung  posteriorly.  Upper 
end  of  left  kidney.  Suprarenal 
glands. 


Upper  pole  of  right  kidney. 


C  8-7.  R  7.12-        Foramen 

of  Winslow.  Pyloric  orifice 
and  first  part  of  duodenum. 
Splenic  flexure  of  colon. 


Foramen  of  Winslow. 
Highest  point  of  first  part  of 
duodenum. 


Beginning  of  abdominal  aorta 
and  origin  of  coeliac  axis. 


68 


UNIVERSITY  OF  MISSOURI  STUDIES 


Li 

Junctions     of     eighth    and 
ninth  costal  cartilages.  Rg-i  2- 
S^.     Inferior  pole  of  spleen. 
Bases    of    suprarenal  glands. 
Hilus  of  left  kidney.   Pyloric 
orifice.     Duodenojejunal  an- 
gle.    Lower  limit  of  body  of 
pancreas.       Fundus    of     gall 
bladder.     Splenic    flexure  of 
colon.   Beginning  of  abdom- 
inal   aorta.        Formation     of 
portal  vein. 

Cg.  R8-12'  Pyloric  orifice 
and  first  part  of  duodenum. 
Hepatic  flexure  of  colon.  Pan- 
creas. Receptaculum  chyli. 
Hilus  of  kidneys.  Renal  arter- 
ies.    Lower  pole  of  spleen. 

Di 

L. 

Cg.        R9.12.       S,.        Hilus 
of    right    kidney.        Hepatic 
flexure  of  colon.    Receptacu- 
lum  chyli. 

Cg.  Rg-ii-  Head  of  pan- 
creas.     Duodenojejunal  angle. 

D, 

Cioi2-       Transverse     duo- 
denum.    Head    of   pancreas. 
Lower  pole  of  left  kidney. 

Lower  pole  of  left  kidney. 

L3 

S3.     Lowest  point  of  trans- 
verse     duodenum.       Lowest 
point   of   head    of   pancreas. 
Lowest  point  of  liver. 

Infracostal  plane.  Third  part 
of  duodenum.  Lower  pole  of 
right  kidney.  Lowest  point  of 
liver. 

D3 

Lower  pole  of  right  kidney. 

Umbilicus. 

L4 

Umbilicus.      S4.         Highest 
point  of  iliac  crests.  Bifurca- 
tion of  aorta. 

Highest  point  of  iliac  crest. 
Bifurcation  of  aorta. 

D4 

Ileocolic  valve.     Formation 
of  vena  cava  inferior. 

L5 

Caecum. Appendix.  Bifurca- 
tion of  common  iliac  arteries. 

Formation  of  vena  cava 
inferior. 

D. 

Anterior       superior       iliac 
spines. 

Anterior  superior  iliac  spines. 
Bifurcation  of  common  iliac 
arteries. 

PLATES 


EXPLANATION  OF  REFERENCE  NUMBERS 
USED  IN  THE  PLATES 

rBNA]  terms  are  used  in  the  table.  English  equivalents  are  given 
in  parentheses.  A  dash  after  a  number  indicates  that  there  is  no  specific 
[BNA]  term  for  the  part. 

2.  N.  phrenicus. 

3.  N.  vagus. 

3A.  N.  laryngeus  inferior. 

3B.  Plexus  oesophageus  posterior. 

3c.  Plexus  oesophageus  anterior. 

4.  Truncus  sympathicus, 
5-     V.  jugularis  externa. 

6.  A.  et  V.  thyreoidea  superior. 

7.  A.  et  V.  vertebralis. 

8.  N.  cervicalis  V. 
g.  N.  cervicalis  VI. 

10.  N.  cervicalis  VII. 

12.  N.  cervicalis  VIII. 

13.  A.  et  V.  transversa  scapulae. 

14.  A.  et  V.  transversa  colli. 
16.  N.  thoracalis  I. 

jy_  r  (upper  trunk  of  brachial  plexus). 

18.  I  Plexus  brachialis  j    (anterior  division  of  upper  trunk). 
J  I   (posterior  division  of  upper  trunk). 

20.  A.  et  V.  cervicalis  ascendens. 

21.  A.  thyreoidea  inferior. 
21A.  V.  thyreoidea  inferior. 

22.  Ductus  thoracicus. 

23.  A.  subclavia. 

24.  A.  etV.  mammaria  interna. 

jr. (lateral  infracostal  vessels). 

26.  Fasciculus  posterior  (posterior  cord  of  brachial  plexus). 

27.  Fasciculus  medialis  (inner  cord  of  brachial  plexus). 

28.  Fasciculus  lateralis  (outer  cord  of  brachial  plexus). 

29.  N.  cutaneus  antibrachii  medialis  (internal  cutaneous  nerve). 

30.  N.  radialis  (musculospiral  nerve). 

31.  N.  cutaneus  brachii  posterior. 

32.  Ramus  muscularis  nervi  radialis. 

33.  N.  axillaris  (circumflex  nerve). 

34.  N.  radialis    (separated    from    main  nerve  by  a  small  vein  at  this 

level). 

35.  A.  axillaris. 

36.  V.  brachialis  (external  vein  of  brachial  venae  comites). 

37.  A.  et  V.  thoracalis  lateralis. 

38.  V.  cephalica. 

41.  N.  musculocutaneus. 

42.  N.  ulnaris. 

71 


72  UNIVERSITY  OF  MISSOURI  STUDIES 

43. -V  r  (outer  head  of  median  nerve). 

44.  In.  medianus-|  (inner  head  of  median  nerve). 

45.  J  V  (median  nerve). 

46.  A.  subscapularis. 

46A,  A.  thoracodorsalis  (long  thoracic  artery "*. 

47.  A.  circumflexa  scapulae. 

48.  V.  circumflexa  humeri  posterior. 

49.  V.  azygos. 

50.  V.  hemiazygos  accessoria. 

51.  V.  hemiazygos. 

52.  N.  splanchnicus  major. 

53.  A.  phrenica  inferior. 

54.  Ductus  hepaticus. 

55.  Ductus  cysticus. 

56.  Ductus  choledochus. 

58.  A.  hepatica  propria. 

59.  A.  gastrica  dextra. 

60.  A.  gastroduodenalis. 

61.  Ureter. 

62.  V.  suprarenalis. 

63.  A.  mesenterica  superior. 

64.  V.  mesenterica  superior. 

65.  V.  mesenterica  inferior. 
65A.  A.  mesenterica  inferior. 

66.  A.  et  V.  lienalis. 

67.  A.  et  V.  spermatica  interna. 

68.  N.  thoracalis  XII. 

69.  N.  lumbalis  I. 

70.  N.  lumbalis  II. 

71.  N.  lumbalis  III. 

72. (common  trunk  formed  by  second  and  third  lumbar 

nerves). 

73.  N.  lumbalis  IV. 

74.  N.  obturatorius. 

75.  N.  femoralis  (anterior  crural). 

76.  N.  lumbalis  V. 

77.  Truncus  lumbosacralis. 

77A. (branch  of    fourth    lumbar   nerve     to  lumbosacral 

cord). 

78.  N.  sacralis  I. 

79.  N.   sacralis  II. 

80.  N.  sacralis  III. 

81.  Funiculus  spermaticus  (spermatic  cord). 

82.  Sinus  coronarius. 

83.  A.  coronaria  [cordis]  dextra. 

84.  Ramus  descendens  anterior  arteriae  coronarise  [cordis]  sinistrae. 
84A.  Ramus  circumflexus  arteriae  coronariae  [cordis]  sinistrae. 

85.  Ductus  deferens. 


PLATE  I 


73 


PLATE  I 

Plate  I  is  from  the  upper  surface  of  section  I  which  passes 
through  the  intervertebral  disc  (Fibrocartilago  interverte- 
bralis  IV)  between  the  fourth  and  fifth  cervical  vertebrae 
posteriorly  and  through  the  thyreoid  and  arytenoid  carti- 
lages anteriorly.  The  dotted  line  is  the  outline  of  section 
II  which  is  1.3  cm.  below  this  plane  and  shows  how  rapidly 
the  body  expands  in  this  region. 

The  plane  of  the  section  is  not  horizontal  but  is  4.4  cm, 
lower  in  front  than  behind,  and  is  a  little  lower  on  the  right 
than  on  the  left  side. 


74 


Pr.ATi-    I. 


-  ..  ^  o  - 

^    (4     O     *^    ^     «      V   *) 


•  '<c     2 


'>5  t?t;j::  t:'  t;   t;  >^t  j^d: 


PLATE  II 


75 


PLATE  II 

Plate  II  is  from  a  section  through  the  intervertebral  disc 
(Fibrocartilago  intervertebralis  V)  between  the  fifth  and 
sixth  cervical  vertebrae  posteriorly,  the  upper  part  of  the 
lamina  of  the  cricoid  cartilage  anteriorly  and  the  upper  sur- 
face of  the  acromial  end  of  the  clavicles  laterally.  The  upper 
surface  of  this  section  is  1.3  cm.  posteriorly  and  .4  cm.  anter- 
iorly below  that  of  section  I,  so  that  the  anterior  margin  is 
3.5  cm.  below  the  posterior. 

The  right  lobe  of  the  thyreoid  gland  is  small  at  the  sur- 
face of  the  section  but  enlarges  a  little  lower  down  and  pro- 
jects backward  and  inward  into  the  space,  indicated  by  the 
dotted  outline,  between  the  pharynx  and  the  prevertebral 
fascia. 


76 


Piwvn-    II. 


^     t; 


PLATE  III 


77 


PLATE  III 

Plate  III  is  from  a  section  through  the  upper  part  of  the 
seventh  cervical  vertebra  posteriorly,  the  arch  of  the  cricoid  car- 
tilage (Arcus  cart,  cricoideae)  anteriorly  and  the  upper  part 
of  the  heads  of  the  humeri  laterally.  The  plane  of  section 
is  1.8  cm.  posteriorly  and  1.1  cm.  anteriorly  below  section 
II  so  that  the  anterior  margin  is  2.8  cm.  below  the  posterior. 


78 


Plati-   111. 


PLATE  IV 


79 


PLATE  IV 

Plate  IV  is  from  a  section  through  the  upper  half  of  the 
first  thoracic  vertebra  posteriorly,  the  middle  of  the  clavicles 
anteriorly  and  the  middle  of  the  glenoid  cavities  of  the 
scapulae  laterally.  The  plane  of  the  section  is  1.3  cm.  pos- 
teriorly and  1.1  cm.  anteriorly  below  that  of  section  III  so 
that  the  anterior  margin  is  2.6  cm.  below  the  posterior. 

The  thoracic  duct  is  cut  through  the  uppermost  part  of 
the  arch.  The  internal  part  is  the  ascending  limb,  the  ex- 
ternal the  descending  limb.  A  valve  is  present  at  the  junc- 
tion of  the  two  limbs. 


So 


Platk  IV 


PLATE  V. 


.     =  PLATE  V 

Plate  V  is  from  a  section  through  the  intervertebral 
disc  (Fibrocartilago  intervertebralis  I)  between  the  first 
and  second  thoracic  vertebrae  posteriorly,  through  the 
inner  third  of  the  clavicles  anteriorly,  and  through  the  lower 
part  of  the  glenoid  cavities  of  the  scapulae  laterally.  The 
plane  of  the  section  is  1.7  cm.  anteriorly  and  1.1  cm.  pos- 
teriorly below  section  IV,  hence  the  anterior  margin  is  3.2 
cm.  lower  than  the  posterior. 

The  axillary  veins  are  not  cut  except  where  other  veins 
open  into  them,  but  each  is  easily  traced  at  the  surface  of 
the  section,  and  is  indicated  in  the  plate  by  dotted  lines. 


82 


Plate  V 


PLATE  VI 


83 


PLATE  VI 

Plate  VI  is  from  a  section  through  the  lower  part  of 
the  second  thoracic  vertebra  posteriorly,  the  sternoclavi- 
cular articulations  anteriorly,  and  through  the  infraglenoid 
tubercles,  and  below  the  spines  of  the  scapulae  laterally. 
The  plane  of  the  section  is  1.7  cm.  anteriorly  and  2  cm. 
posteriorly  below  section  V  so  that  the  anterior  margin  is 
2.9  cm.  lower  than  the  posterior. 

The  left  innominate  vein  (V.  anonyma  sinistra)  crosses 
the  median  line  in  this  section  and  unites  with  the  right  in- 
nominate vein  (V.  anon3^ma  dextra)  about  2  cm.  to  the  right 
of  the  midline.  Its  course  across  the  mediastinal  space  is 
indicated  by  dotted  lines. 


84 


Plate  \'I. 


PLATE  VII 


PLATE  VII 

Plate  VII  is  from  a  section  through  the  uppermost  part 
of  the  fourth  thoracic  vertebra  posteriorly  and  the  upper 
part  of  the  first  intercostal  spaces  anteriorly.  The  plane  of 
the  section  is  2.1  cm.  anteriorly  and  2.8  cm.  posteriorly 
below  the  last  section.  The  anterior  margin  is  2.2  cm. 
lower  than  the  posterior. 


86 


Plate  \I1. 


PLATE  VIII 


87 


PLATE  VIII 

Plate  VIII  is  from  the  upper  surface  of  a  section 
through  the  upper  third  of  the  body  of  the  fifth  thoracic 
vertebra  posteriorly,  and  the  lower  part  of  the  second  in- 
tercostal space  anteriorly.  The  plane  of  the  section  is  2.8 
cm.  below  that  of  the  preceding  section.  The  anterior 
margin  is  2.2  cm.  lower  than  the  posterior. 

The  posterior  semilunar  valve  of  the  pulmonary 
orifice  is  left  in  this  section,  the  right  and  left  anterior 
semilunar  valves  were  removed  with  the  section  above. 
The  pulmonary  artery  lies  almost  entirely  in  the  section 
above  this. 

The  pericardial  cavity,  though  wide  in  this  section,  is 
very  shallow,  being  filled  by  the  widening  out  of  the  right 
auricle  and  ventricle  at  a  slightly  lower  level,  and  the  ap- 
pearance of  the  left  auricular  appendix  in  the  left  posterior 
part  of  the  cavity. 

The  vena  cava  superior  enters  the  right  auricle  (Atrium 
dextrum)  about  .5  cm.  below  the  surface  of  the  section.  The 
section  is  through  the  apex  of  the  right  auricular  appendix. 


SS 


Plate  VIII. 


PLATE  IX 


PLATE  IX 

Plate  IX  is  from  the  upper  surface  of  a  section  through 
the  upper  third  of  the  body  of  the  sixth  thoracic  vertebra 
posteriorly  and  the  upper  part  of  the  articulations  of  the 
third  costal  cartilages  with  the  sternum  anteriorly.  The 
plane  of  the  section  is  1.8  cm.  anteriorly  and  2.2  cm. 
posteriorly,  below  the  plane  of  the  last  section.  The 
anterior  margin  is  1.8  cm.  lower  than  the  posterior. 

The  cavity  of  the  left  auricle  is  divided  into  an  anterior 
and  a  posterior  chamber  by  a  peculiar  thin  fibrous  septum, 
perforated  by  several  foramina,  which  permitted  the  free 
passage  of  blood  through  the  auricle.  The  lower  portion 
of  the  septum  is  shown  in  Plate  X.  This  anomaly  is  fully 
described  in  the  Journal  of  Anatomy  and  Physiology, 
XXXIX.  p.  69. 


90 


Platk  IX. 


PLATE  X 


91 


PLATE  X 

Plate  X  is  from  the  upper  surface  of  a  section  through 
the  upper  third  of  the  body  of  the  seventh  thoracic  verte- 
bra posteriorly  and  the  lower  part  of  the  third  intercostal 
space  anteriorly.  The  plane  of  the  section  is  1.3  cm.  anter- 
iorly and  2.2  cm.  posteriorly  below  that  of  the  last  section, 
making  the  anterior  margin  of  the  section  .9  cm.  lower  than 
the  posterior. 


Plate  X. 


PLATE  XI 


93 


PLATE  XI 

Plate  XI  is  from  the  upper  surface  of  a  section  through 
the  intervertebral  disc  (Fibrocartilago  intervertebralis 
VII)  between  the  seventh  and  eighth  thoracic  vertebrae 
posteriorly  and  through  the  fourth  stemochondral  articu- 
lations anteriorly.  The  plane  of  the  section  is  1.5  cm.  anter- 
iorly and  2.4  cm.  posteriorly  below  that  of  the  last  section, 
so  that  it  is  horizontal. 


94 


Plate  XL 


^^^^J<; 

m\^ 

v^ 

(lilt 

M 

T/ 

'  \^ 

\ 

\     v^3^ 

A 

\ 

\     >  2  '-'■2 

.5 

•0 

n 
5 

ft 

2  2-E^ 

% 

3 

^ 

.0  «,  ^  « 

V 

^ 

r  ~  c  .c 

0) 

5 

^3 

0) 

a" 

:i^^-' 

PLATE  XII 


95 


PLATE  XII 

Plate  XII  is  from  the  upper  surface  of  a  section  through 
the  uppermost  part  of  the  disc  between  the  eighth  and  ninth 
thoracic  vertebrae  posteriorly  and  the  articulations  of  the 
fifth  costal  cartilages  with  the  sternum  anteriorly.  The 
plane  of  the  section  is  2.5  cm.  below  that  of  the  last  section 
and  is  horizontal. 

The  vena  cava  inferior  pierces  the  diaphragm  and  en- 
ters the  inferior  and  posterior  part  of  the  right  auricle 
(Atrium  dextrum)  near  the  upper  surface  of  this  section. 
What  is  labeled  vena  cava  inferior  in  the  plate  is  in  reality 
the  lowest  part  of  the  auricle  into  which  the  vein  opens 
about  .5  cm.  below  the  surface  of  the  section. 

The  right  pleural  cavity  appears  exaggerated  in 
size  in  this  figure,  on  account  of  the  great  width  of  the 
shallow  space  between  the  base  of  the  lung  and  the  super- 
ior surface  of  the  diaphragm.  A  similar  exaggeration  is 
seen  in  the  pericardial  cavity. 


96 


Flath  XI 1. 


PLATE  XIII 


97 


PLATE  XIII 

Plate  XIII  is  from  the  upper  surface  of  a  section 
through  the  intervertebral  disc  (Fibrocartilago  interver- 
tebralis  IX)  between  the  ninth  and  tenth  thoracic  verte- 
brae posteriorly  and  the  sternoxiphoid  articulation  anter- 
iorly. The  plane  of  the  section  is  1.9  cm,  anteriorly  and  2.1 
cm.  posteriorly  below  that  of  the  last  section,  and  is  .2  cm. 
lower  behind  than  in  front. 

The  lowest  portion  of  the  pericardial  cavity  appears  as 
a  shallow  space  separating  the  diaphragm  from  the  fifth 
left  costal  cartilage.  In  reality  this  space  is  occupied  by 
the  tip  of  the  apex  of  the  heart,  which  by  an  oversight  was 
omitted  from  the  plate. 

The  oesophagus  is  turning  to  the  left  of  the  midplane 
preparatory  to  entering  the  stomach  in  this  section.  The 
upper  pole  of  the  spleen  (Lien)  comes  nearly  to  the 
surface  of  the  section  between  the  posterior  surface  of  the 
stomach  and  the  diaphragm. 


98 


Plate  XIII. 


PLATE  XIV. 


99 


PLATE  XIV 

Plate  XIV  is  from  the  upper  surface  of  a  section 
through  the  intervertebral  disc  (Fibrocartilago  interver- 
tebralis  X)  between  the  tenth  and  eleventh  thoracic  verte- 
brae posteriorly  and  the  middle  of  the  xiphoid  process  an- 
teriorly. The  plane  of  the  section  is  3.0  cm.  anteriorly  and 
2.8  cm.  posteriorly  below  that  of  the  last  section,  so  that  it 
is  1  cm.  lower  posteriorly  than  anteriorly. 


I  GO 


Plate  XIV, 


PLATE  XV 


lOI 


PLATE  XV 

Plate  XV  is  from  the  upper  surface  of  a  section  through 
the  intervertebral  disc  (Fibrocartilago  intervertebralis 
XI)  between  the  eleventh  and  twelfth  thoracic  vertebrae 
posteriorly,  and  the  tip  of  the  xiphoid  process  anteriorly. 
The  plane  of  the  section  is  2.7  cm.  posteriorly  and  3  cm. 
anteriorly  below  that  of  the  last  section.  Its  posterior  mar- 
gin is  .7  cm.  lower  than  its  anterior. 

The  stomach  and  spleen  are  separated  from  each  other 
by  a  recess  of  the  lesser  peritonaeal  cavity  (Recessus  lienalis 
bursae  omentalis).  This  recess  of  the  lesser  cavity  is  con- 
tinuous slightly  below  the  surface  of  the  section  with  the 
vestibule  of  the  lesser  cavity  by  a  passage  way  (sometimes 
called  "Huschke's  foramen")  bounded  by  the  lesser  curva- 
ture of  the  stomach  anteriorly,  and  the  plica  gastropancrea- 
tica  posteriorly. 


102 


Plate  XV. 


PLATE  XVI 


103 


PLATE  XVI 

Plate  XVI  is  from  the  upper  surface  of  a  section 
through  the  lowermost  portion  of  the  twelfth  thoracic  ver- 
tebra posteriorly  and  the  costal  cartilages  of  the  eighth  ribs 
anteriorly.  The  section  is  2.5  cm.  anteriorly  and  2  cm.  pos- 
teriorly below  the  plane  of  the  last  section.  The  posterior 
margin  is  .2  cm.  lower  than  the  anterior. 

The  common  bile  duct  (56)  lies  external  to  the  portal 
vein  and  the  hepatic  artery.  The  cystic  duct  (55)  is  cut 
at  its  origin  at  the  neck  of  the  gall  bladder  (CoUum  vesi- 
cae felleae).  The  cystic  and  hepatic  ducts  unite  in  the 
lower  part  of  the  section  above  to  form  the  common  bile 
duct.  The  sections  of  the  intestine  are  numbered  con- 
secutively, as  they  would  be  encountered  in  passing  down 
the  alimentary  canal.  The  letter  is  the  initial  letter  of 
the  name  of  the  part  and  the  subscript  denotes  the  num- 
ber of  the  serial  section.  The  letter  I  has  been  used  to 
denote  jejunum  as  well  as  ileum. 


104 


Plate  X\  I. 


"  V^^  4   J    <» 


PLATE  XVII 


105 


PLATE  XVII 

Plate  XVII  is  from  a  section  through  the  lower  third 
of  the  first  lumbar  vertebra.    The  plane  of  the  section  is  2-.8 

cm.  anteriorly  and  2.7  cm.  posteriorly  below  that  of  Plate 
XVI  so  that  the  posterior  margin  is  .1  cm.  lower  than  the 
anterior. 

The  left  renal  vein  empties  into  the  vena  cava  inferior 
near  the  surface  of  the  section.  Its  course  is  indicated  in 
the  plate.     It  receives  the  suprarenal  vein  (62)  from  above. 

The  lower  part  of  the  first  portion  of  the  duodenum 
(Dj)  is  attached  to  the  posterior  part  of  the  stomach.  The 
posterior  of  the  two  segments  marked  (Dj)  continues 
downward  as  the  descending  duodenum.  The  last  portion 
of  the  duodenum  (D^)  lies  to  the  left  of  the  midline  op- 
posite the  first  portion. 


io6 


Plate  XVII. 


-s.^si  I     2  lit 


«  s 


s  S 


PLATE  XVIII 


107 


PLATE  XVIII 

Plate  XVIII  is  from  the  upper  surface  of  a  section 
through  the  lower  half  of  the  body  of  the  second  lumbar 
vertebra.  The  plane  of  the  section  is  3.3  cm.  anteriorly  and 
2.8  cm.  posteriorly  below  that  of  the  last  section  hence  its 
anterior  margin  is  A  cm.  lower  than  its  posterior. 


1 08 


Plate  XVIII. 


n  « 


PLATE  XIX 


109 


PLATE  XIX 

Plate  XIX  is  from  the  upper  surface  of  a  section 
through  the  lower  third  of  the  third  lumbar  vertebra.  The 
plane  of  the  section  is  3.7  cm.  anteriorly  and  3.8  cm.  poster- 
iorly below  that  of  the  last  section,  so  that  the  anterior 
margin  is  .3  cm.  below  the  posterior. 


no 


Plate  XIX. 


PLATE  XX 


III 


PLATE  XX 

Plate  XX  is  from  the  upper  surface  of  a  section  through 
the  middle  of  the  body  of  the  fourth  lumbar  vertebra.  The 
plane  of  the  section  is  2.8  cm.  anteriorly  and  3.1  cm.  poster- 
iorly below  that  of  the  last  section  and  is  horizon- 
tal. It  passes  just  above  the  highest  point  of  the  crest  of 
the  ilium. 


112 


Plate  XX. 


*  2   f"* 


PLATE  XXI 


"3 


PLATE  XXI 

Plate  XXI  is  from  the  upper  surface  of  a  section 
through  the  lowermost  part  of  the  fifth  lumbar  vertebra. 
The  plane  of  the  section  is  4.3  cm.  anteriorly  and  3  cm.  pos- 
teriorly below  that  of  the  last  section.  Its  anterior  margin 
is  1.3  cm.  lower  than  its  posterior.  • 


114 


PLATli    XXI. 


PLATE  XXII 


'^5 


PLATE  XXII 

Plate  XXII  is  from  the  upper  surface  of  a  section 
through  the  middle  of  the  sacrum.  The  plane  of  the  section 
is  4  cm.  anteriorly,  and  3.1  cm.  posteriorly  below  that  of 
the  last  section,  so  that  the  anterior  margin  is  2.2  cm.  lower 
than  the  posterior. 

The  left  plica  umbilicalis  lateralis  extends  across  the 
corner  of  the  peritonaeal  cavity  in  the  section  cutting  off  a 
small  pocket  as  indicated  by  the  dotted  line. 


ii6 


Plate  XXII. 


PLATE  XXIII 


117 


PLATE  XXIII 

Plate  XXIII  is  from  the  upper  surface  of  a  section 
through  the  first  coccygeal  vertebra  posteriorly  and  the 
acetabular  cavities  of  the  ilia  laterally.  The  plane  of  the 
section  is  3.8  cm.  anteriorly  and  4.2  cm.  posteriorly  below 
that  of  the  last  section.  The  anterior  margin  is  1.8  cm. 
lower  than  the  posterior. 

The  right  plica  umbilicalis  lateralis  stretches  across  the 
corner  of  the  cavity  cutting  oflf  a  pocket  like  the  one  in- 
dicated on  left  side  of  section  XXII.  These  two  spaces 
are  conical  in  form,  about  4  cm.  deep  and  closed  everywhere 
except  at  the  top. 


iiS 


Plate  XXIII. 


PLATE  XXIV 


119 


PLATE  XXIV 

Plate  XXIV  is  from  a  section  through  the  tip  of  the 
coccyx  posteriorly,  the  middle  of  the  body  of  the  os  pubis 
anteriorly  and  the  superior  rami  of  the  ischia.  The  plane 
of  the  section  is  4.3  cm.  anteriorly  and  4.5  cm.  posteriorly 
below  that  of  section  XXIII  so  that  the  anterior  margin  is 
1.3  cm.  below  the  posterior. 


I20 


Plate  XXTV 


PLATE  XXV 


121 


PLATE  XXV 

Plate  XXV  is  from  a  section  through  the  ischial  tuber- 
osities and  the  lesser  trochanters  of  the  femurs.  The  sec- 
tion is  4.3  cm.  anteriorly  and  5.4  cm.  posteriorly  below  the 
last  section.  The  anterior  margin  is  .2  cm.  below  the  pos- 
terior. This  is  about  4.5  cm.  below  the  tip  of  the  coccyx 
and  2.3  cm.  below  the  inferior  margin  of  the  symphysis 
pubis. 


122 


Plate  XXV. 


Plate  XXV. 


PLATE  XXVI 


123 


PLATE  XXVI 

Plate  XXVI  is  from  a  photograph  of  the  anterior  sur- 
face of  the  trunk,  reconstructed  by  piling  up  the  sections 
in  their  proper  order,  and  is  reduced  to  about  one-fourth 
life  size. 


124 


I'LATK    XX\I. 


PLATE  XXVII 


125 


PLATE  XXVII 

Plate  XXVII  is  from  a  photograph  of  the  posterior 
surface  of  the  trunk,  shown  in  Plate  XXVI  and  reduced 
in  the  same  proportion. 

The  photographs  were  taken,  in  order  to  show  the  exact 
position  of  each  section  and  its  relations  to  the  various 
landmarks  of  the  body. 

The  number  on  each  section  corresponds  to  the  num- 
ber of  the  plate  showing  the  upper  surface  of  that  section. 


126 


rLATl-    XX\    11. 


PLATE  XXVir. 


127 


PLATE  XXVIII 

Plate  XXVIII  represents  a  projection  of  the  various 
internal  organs  upon  the  anterior  surface  of  the  body  re- 
duced to  one-half  life  size.  The  body  outline  was  obtained 
by  enlarging  to  life  size,  with  a  pantograph,  the  photo- 
graphs used  in  making  Plates  XXVI  and  XXVII.  The 
errors  of  proportion  produced  by  the  photographic  lens 
were  corrected  by  measurements  of  the  body  at  the  surface 
of  each  section.  The  section  lines  seen  in  Plate  XXVI  are 
represented  in  this  plate  by  the  horizontal  black  lines 
which  run  across  the  body.  The  exact  position  of  these 
lines  was  obtained  by  placing  the  sections  one  upon  the 
other  in  their  proper  position  as  was  done  to  take  the 
photographs  shown  in  Plates  XXVI  and  XXVII.  A  meter 
stick  was  then  placed  perpendicularly,  parallel  to  the  anter- 
ior midline  of  the  body  and  the  position  of  the  upper  sur- 
face of  each  section  was  measured  by  running  a  straight 
edge  horizontally  outward  from  the  section  to  the  meter 
stick. 

The  vertical  line  marked  OO  in  this  plate  and  in  Plate 
XXIX  is  the  midline  of  the  body.  In  the  anterior  projection 
it  connects  the  anterior  ends  of  the  midlines  of  the  sections. 
In  the  posterior  projection  it  connects  the  posterior  ends 
of  these  same  midlines. 

The  various  organs  are  outlined  in  broken  lines  of  suf- 
ficiently different  character  sc  that  each  organ  may  be 
traced  without  an}-  difficulty.  (These  lines  are  explained 
on  the  plates. 


12S 


m^ 


Plate  XXVIII. 


PLATE  XXIX 


129 


PLATE  XXIX  ■     , 

Plate  XXIX  represents  a  projection  of  the  same 
structures  upon  the  posterior  surface  of  the  body,  also 
reduced  to  one-half  life  size.  The  body  outline  was 
obtained  in  the  same  way  as  in  Plate  XXVIII.  The  section 
lines  correspond  to  those  in  Plate  XXVII  and  were  located 
in  the  same  way  as  those  in  Plate  XXVIII.  The  positions 
of  the  section  lines  are  not  exactly  the  same  in  this  plate  as 
in  Plate  XXVIII  since  many  of  the  sections  differ  in  thick- 
ness at  their  anterior  and  posterior  surfaces. 


130 


Plate  XXIX. 


PLATE  XXX 


13J 


PLATE  XXX 

Plate  XXX  represents  a  projection  of  the  internal 
structures  upon  the  right  lateral  surface  of  the  body 
reduced  to  one-half  life  size.  The  OO  line  is  the  mid- 
axillary  line  which  was  determined  by  placing  the  sections 
in  their  normal  positions,  as  in  obtaining  Plates  XXVI  and 
XXVII,  and  drawing  a  vertical  line  down  through  the 
middle  of  the  axilla.  The  section  lines  correspond  to  those 
seen  in  the  preceding  plates. 


132 


Plate  XXX. 


PLATE  XXXI 


133 


PLATE  XXXI 

Plate  XXXI  represents  a  projection  of  the  same  struc- 
tures upon  the  left  lateral  surface  of  the  body,  also  re- 
duced to  one-half  life  size.  The  OO  line  in  this  plate  is 
the  left  midaxillary  line. 

The  measurements  for  the  lateral  projections  were  made 
in  the  same  way  as  for  the  anterior  and  posterior,  using 
the  midaxillary  plane  instead  of  the  midplane.  In  this 
case,  however,  it  was  not  necessary  to  make  corrections 
for  the  obliquity  of  the  surfaces,  except  in  one  or  two 
cases.  Each  organ  is  outlined  in  the  same  character  of  line 
in  the  lateral  projections  as  in  the  anterior  and  posterior 
projections. 

The  ruled  lines  of  the  green  background  in  Plates 
XXVIII  to  XXXI  represent  the  millimeter  spaces  on  the 
life  size  chart,  reduced  to  the  same  scale  as  the  figures. 


134 


Plate  XXXI. 


til      ,11    S^ 


PLATE  XXXII 


135 


PLATE  XXXII 

Plate  XXXII  is  a  reduced  copy  in  colors  of  Plate 
XXVIII  which  represents  the  organs  as  projected  upon  the 
anterior  surface  of  the  body. 

This  Plate  and  the  three  following  Plates  are  all  reduced 
to  about  one-fourth  life  size.  In  order  to  bring  out  more 
clearly  the  intricate  relations  of  the  various  organs  shown 
in  outline  in  Plates  XXVIII  to  XXXI  each  organ  is  shown 
in  a  distinctive  color  in  Plates  XXXII  to  XXXV.  The  col- 
ors used  for  the  various  organs  are  indicated  on  the  plates. 


136 


Plate  XXXII. 


fES   Lunq. 

I  /dantf  UrftfT.  Bitt4drr 
t        1  fliqht  tmrriclt 

r*~1  Rl^.r  OMHCtt 

I        1  Lrfr  frnnltlr.  fiorlt. 

I J  Lrfl  auriHr 

CD  Lintr 

cm  V™ 

nm  flt;^crfOJ 
F"^^  iiiprflrria). 

■■■  Duodenum 
I         TracVa  Bnnihi 
a Colon  /ippe(>dil  fifCtUm. 

VfrTf »raJ  colimn 

Pf/icordiiini 


J 


PLATE  XXXIII 


137 


PLATE  XXXIII 

Plate  XXXIII  is  a  reduced  copy  in  colors  of  Plate 
XXIX  which  represent  the  organs  as  projected  upon  the 
posterior  surface  of  the  body.    One-fourth  life  size. 


^38 


Plate  XXXIII. 


U 


PLATE  XXXIV 


139 


PLATE  XXXIV 

Plate  XXXIV  is  a  reduced  copy  in  colors  of  Plate 
XXX  which  represents  the  organs  projected  upon  the  right 
lateral  surface  of  the  body.     One-fourth  life  size. 


140 


Pr.ATE  XXXI\ 


■■"•  1 


qhr  auricle 

\0,tr 

'HZSBloddfr. 

tSS^Tnfrroid  tfland. 

Boilf  outline. 

SHelihn. 

Trachea 

Colon. 

Verfrbral  ctl^mn, 

Pericardi'UTt 


^ 


x. 


PLATE  XXXV 


141 


PLATE  XXXV 

Plate  XXXV  is  a  reduced  copy  in  colors  of  Plate  XXXI 
which  represents  the  organs  projected  upon  the  left  lateral 
surface  of  the  body.    One-fourth  life  size. 


N. 


142 


Plate  XXXV 


Ltti  omrKic 
Lett  ventricle  CZ3 
Aorta.  '£Z3 

flight  t/tntncif 
Li^er. 
KiantyUrtter.  ^9 
Bktddtr  m 

Splun  I        I 

Thfrtoid  qlana 

OuodtniA^m         •^■» 
Co/on  ftfcfum  ./ 

S»rf^  tutlini 
Strlrt*!!.     - 


V 


jti^y6 


/-A^,f 


V 


